Large Obstruction/impaction In Dad's Right Abdomen
Please respond fast. He could DIE soon.
Let me get a few things out of the way first:
My Dad is 60 years old, overeats at every sitting and eats maybe up to 5 times a day, and loves bread/cheese. He is almost 300lbs and has a ZERO physical activity daily routine since he is recently retired a lil early.
Dec 19th Dad had his last full meal (today's the 22nd)
Lost his appetite since then
Dec 20th developed low right quadrant abdomen pain; bad, but not unbearable
He has no fever, no vomitting, or unbearable pain (again)
Took him to the ER 20th - 21st
Xray, Blood, Urine, Ultrasound done
Results were BS level of 188 and nothing else revealed but from the xray. The BS is a possible diabetes find and not surprising to me as he does not take his health seriously at all on a daily basis other than taking antibiotics for sinus infections which he gets often which now take him 2 to 4 months to recover from.
Xray showed a VERY large amount of impaction in the right abdomen. I would say it was about at LEAST 1 foot long and perhaps 1 - 2 inches in diameter all stopping at his lower right quadrant.
He is refusing CT scan due to an extreme case of claustrophobia even though its the machine that is NOT enclosed... he still has to go through the donut part which is about 1 foot worth of enclosing just his abdomen. He just feels trapped and like he can't breath when the reality is he can and it was the best room he could've asked for with cold air blowing around forcefully and a wide open breathing space for his face. He refuses it so much that they had to have him sign papers stating that he refused it. They will not treat him until they can do a CT scan. All they've done are tests. We have tried psychological stimulation, tricks, and they gave him meds to relax that wore off just as he was going into the CT scan. They offered more relaxation meds, but he refused it due to his claustrophobia again and it is more real than ever. I've never seen anyone panic like he did once he was on the CT scan table.
ER doc's state that its just a 10 - 15% chance it is appedix or something that severe because it likely would've surfaced with the worst signs by now and other friends in the medical field say he probably would've been dead by now. This is the ONLY saving grace I have easing worries at this point.
I am fully aware of how serious this matter is and that he could die. Last night despite the ER stating they wanted us back and not to give him anything because they wanted to evaluate him further (which basically means 12 more hours of the same tests which lead to NOTHING since he refuses the CT scan) my mother gave him 2 enema's and probably 1 of those was done the proper way (the 2nd one). After the 2nd one he let out some waste. This would mark the 3rd Diarrhea like movement since yesterday (the 21st) though after the 2nd enema he passed "some" (very little) solids about 1 to 2 inches wide at most. After the 2nd enema he went to bed and this morning (Dec 22nd) he drank a whole bottle of Magnesium Citrate. It is my understanding that it takes anywhere from 30 minutes to 6 hours to work which would put us at about 12 noon CDT time.
Also, last night (21st) he got on the treadmill for 2 sets of 10 minutes each at .7 to 1.2 mph. This almost IMMEDIATELY seemed to help, he was walking better, and the pain went away almost 90%
Is appendicitis associated with impactions/blockages? or usually not?
Are we doing everything we can to get him to pass the impaction?
Should we continue the treadmill runs? I would think so, but want to hear thoughts on it.
Should we continue to give him MORE Magnesium Citrate if by Noon CDT he hasn't had a movement?
Should we continue to give him more enema's?
Should he be eating or drinking at ALL?
What should he eat/drink?
I'm concerned about him not having eaten, though yesterday my mom gave him some beats and chicken broth and he ate/drank it all. He also has a sinus infection which he is taking amoxicillin (antibiotic) for. His impaction pains started around the same time his infection worsened and/or same time he started taking the amoxicillin, but I'd think the infection would've possibly worsened his condition rather than the antibiotic.
I would think we should continue the enemas and mag citrate continually around the clock, but I'm unaware of the duration of spacing of time we should do between them. I'm also worried about him bursting/tearing his colon inside if we give him more of the mag citrate.
The ER is covering their butt by wanting him back over there, but at the same time they did nothing for him to help pass the impaction for over 13 hours. Yes the tests are necessary, but so is action.
I have read about Colon Cleansing products and many say those are just scams, but at this point with an impaction I'm not sure even if they really did work if they'd help or make things worse anyway. Thoughts?
Thank you for anyone reading. This is very important to respond to fast. He could die soon.
Because the mag citrate didn't make his pain worse, and resulted in a BM, I don't think he was obstructed. That's why the CT scan was of utmost importance - you don't want to go stimulating a bowel that is obstructed. There really was nothing the ER could do without that information.
For now, since he's had a pretty thorough colon cleanse, I'd give him a couple days on a decent diet and see if he continues to improve. It sounds like a major case of constipation to me. And yes, it really can hurt that badly!
Colon cleansers really are scams. They contain the same stuff in any over-the-counter laxative - lots of fiber like psyllium or flaxseed to make you go. The worst offenders put in a substance (the name escapes me just now) that causes some pretty spectacular looking BMs, and try to convince people that this is "sludge" that has been in their bowels for years. Simply not true.
You already know what the problem is. Your dad needs to eat right and exercise or this problem will come up again. Hopefully he learned that lesson. :-)
Well, define BM for me. I know it stands for bowel movement, but I considered a BM to be only solids... is it also mushy solids/fluids and straight fluids.... or if anything comes out at all in general? We've been operating under the pretense that a successful BM would be with solids coming out which has not been the case maybe but 1 of the times he went.
Today he took Miralax at a local doctor's advice for 9 hours straight - 1 dose per hour mixed in with 8 ounces of water/gatorade each time. He would go and have mushy/liquid movements, but again no solids and nothing insanely productive as far as quantity goes. The doc told him to keep taking it until he had a movement or until the bottle was empty... but with us not knowing what exactly a movement is termed as and with him still having ab pain (though about half as bad now) we kept giving it to him.
He's had enough of all this for today. My mother gave him 2 cups of hot chicken broth to drink and he seems to think thats helping him. He wants no more of the Miralax, or Enema, or Mag citrate till tomorrow. So the plan for the morning is to start off first with two bottles of Mag Citrate and then an enema a lil while after. My main concern with the enema is that the amount of fluid that is in one of those small *** bottles just isn't enough to reach where his impaction is/was. I don't know what else you'd call it if not an impaction cause it was all lodged in his right abdomen where it was causing the pain according to the xray.
Jaybay - Thanks so much for replying. I posted in ehealtforum.com too and got no response. Just for future reference besides this site what other good medical forums are out there? Links would be nice. thanks again Jaybay!
Jaybay always gives excellent information. I have had a couple impactions, where stool hardens and won't come out, to where I vomited because nothing would stay down. I have also had lots of gastro problems. So, I'm going to tell you what I think about your Dad.
I think those doctors at the ER are not handling this very well. I think you should even consider going to a larger hospital ER in a nearby city. I fully understand his fear of the CAT scan machine. But see, they need a reason to take him to the operating room, and ultrasound is not enough. But they also don't want to intubate him and put him under anesthesia just for the CAT scan. However, they could have put him in twilight sleep, they inject it in a vein, which does not require keeping his airway open to knock him out. This is what gastroenterologists do for the colonoscopy exam. Twilight sleep makes a person feel wonderful, takes away all fear, sometimes all memory, of whatever procedure is going on. I would ask for that. Because I think he SHOULD be operated on, and apparently only a CAT scan is going to reveal enough evidence for that. Another medication that stops fear is Klonopin, at least .5 mg. People who have panic disorder take it, I take it. Allows me to do most things I am afraid of. Since he's not on it, that first dose ought to get him in that machine within 30 minutes, easy.
I also would like to comment on the various natural things your family is trying with your Dad. First, stop his antibiotics IMMEDIATELY. Antibiotics are notorious for stopping up the bowel. He's only using them for his sinuses, which is not life-threatening, so I can see no harm in stopping those. Second, and I tell people this all the time, but it is true, he needs to restore the "good" bacteria in his intestines that the antibiotics have killed off. Acidophilus products, like acidophilus milk, Activia yogurt, can be purchased at the grocery store. As long as he stops the antibiotics, he can consume those (otherwise he'll throw up). Those "good" bacteria products help break down waste.
As for laxatives, it could be they will not produce results if his waste is very hardened. I had stuff in my colon that was like rocks and had to be dug out by hand, mine was near the end of the large bowel. So, I think all that extra push produced by laxative ain't gonna get it out. And the enemas, they may NOT reach the place where his obstruction is. You said right abdomen, which is the end of the small bowel and the beginning of the large bowel. The enema water may not reach it if it's in the small bowel. I mean, it can't hurt to do it, and I think you should, but just keep in mind it may not work..
Your Dad should quit drinking Gatorade and switch over to water. Regular Gatorade has too much sodium, which dries out a person. The Gatorade "X-Factor" brand can be substituted, though, less salt. His exercise program is also a good idea, keeps blood and oxygen flowing to the body systems.
As for other forums to consult, there is a "pay" Ask The Doctor forum right here at this website. The link is to the left of the list of gastro posts. Go in there and ask a physician, see what they recommend. But in general, depending on the seriousness of your Dad's situation, he ought to be seeing a gastroenterologist, try to get in for a consult right away, ask if they'll do some plane black & white X-rays and come up with advice from those. They may be too busy to do a squeeze-in emergency appointment, tho. If that's the case, then pick an internal medicine physician group, they should be able to provide you with a special appointment. They have plane X-ray machines there, he just has to stand in front of one, or lay on a table, but he will not have to go through that CAT tunnel deal.
I know this is long, and I apologize, but I wanted to try to give as much information as I could. There are several worst-case scenarios for your Dad: Some of his bowel could "die," that is, it will have to be removed eventually, or the bowel could rupture and waste will enter the abdomen and could make him critically ill, and then there is the possibility that he has a cancer that is blocking him and of course cannot be allowed to enlarge and thus threaten other organs in his body. In the last two events, you will be able to tell if he's losing it, he'll get unbelievably sick and vomit and pass out, and then the docs will have no choice but to operate, CAT scan or not.
The thing that bothers me the most about the whole situation, and what caused me to respond to this post, is that he's got a foot-long obstruction, it's in the area of the small bowel, and I personally don't see how in the world the docs expect it to "pass" all by itself from the natural means you are trying. The ER docs are not doing enough to get your Dad in a state where he will accept the CAT scanner. And on top of that, under no circumstances should they have let him go home, he should have been admitted, a gastro consult could have showed up the very next day and so on. I mean, common sense tells you that his problem can get very serious in a very short period of time, and if that bowel blows into the rest of his abdomen, they are going to have one hell of a problem on their hands when he's rolled in on an emergency stretcher.
Hope this helps. Try to get him into a regular doctor's office this week, either internal medicine or gastroenterology practice, or ask the ER docs to give him twilight sleep or big-time anti-panic medicine like Klonopin for the scan, or go to another ER in another town. He should stop the antibiotics now, then go get some Acidophilus for him to restore "good" bacteria that breaks down waste, and switch him to water instead of Gaterade.
Please keep me posted as to his conditions and tell us what you decide to do to change the situation. I and Jaybay will both be here to cheer you on. And I part with a prayer that your Dad get the help he so desperately needs very soon. By the way, don't be afraid of chewing out those ER people. My comments to them would be, "Oh, good grief, for crying out loud, he's got a foot-long obstruction in his small intestine, and you people won't at least admit him?!?"
ggreg - Thanks so much. I have no problem reading posts as long as you want to type out. I really really appreciate it.
We started him this morning on 2 mag citrates and was going to do an enema, but he didn't want it. He's been letting out loads of mush today.. loads and claims he's feeling a lot better (lots of churning in the belly today; lots), though I have not seen him regain appetite which tells me he isn't out of the woods yet though he is trying to act like he is. Right now he's sleeping which is what he's been doing most of the day when not on the pot. He won't do the treadmill anymore and he should be. He claims the pain is much less now, but not gone which to me says there is still hard stool in there.
I hear ya about the water from the enema not reaching his blockage. They didn't even show us the xray personally. I had to peak at it myself when they didn't think I was looking and I know it was his. From where I was standing it seemed to run the length of his whole right abdomen/colon on that side and was pretty wide so I'd say it was the entire ascending colon (as seen here: http://www.webmd.com/hw-popup/large-intestine) that was stopped up based on the xray picture I saw. I just never have understood why doctor's will not show the patient the xray.
Good notes on the twilight state, antipanic and antibiotic stuff. Though I know for sure he will not get off the antibiotic so I'm going to have to wait till he finishes it off. He's a firm believer he will DIE if he doesn't have his antibiotic for his sinus infections.
The ER we went to was a free one cause Dad doesn't have health insurance so this could explain some of the lack of experience and more creative decisions etc.. They gave him something while he was waiting to do the cat scan and it really zonked him out... all pain everywhere was gone... but his mind was still active.... though confused he seemed at times and his eyes got VERY VERY WIDE open with a glaze on them. Its really something though to have to suggest to the doctor's what to do even though some are med students they run it by real doctor's immediately and they work in on the session with the patient. I don't know what you mean by admitted though because he was admitted into the ER "adult walk in clinic", had an IV, did xrays, blood, urine, and ultrasound... so I would think that means he was admitted unless you meant given a room n stuff to be observed. I really do agree with you though that they could've been more creative with anti-panic meds. They did try to give him more of that stuff that made him feel pain-free, relaxed, and glassy glazed eyed with eyes wide open, but he refused it because his fear had already kicked in at the cat scan room when the 1st dose of this injection was wearing off.
I suppose the most interesting thing I learned here is to stop the gatorade which made him feel better and switch to water only which he is very belligerent about drinking. He was only drinking about 2 8 ounce glasses of it a day. I will either give him at least 1 of those only and try to get him to drink 2 or 3x that amount in water. I can't stop the gatorade totally though unless he drinks just 1 can of slim fast (he started that today) though my friend who I've been able to talk to recently (a nurse) says unless he keeps drinking water that the slim fast can actually bulk him up more cause it has fiber and he can't have fiber without water right now as she said. I'll write more later.
My biggest deal is that i thought we were waiting for SOLIDS to come out rather than just mush.... I'm having a problem understanding if he's just passing the fluids and slim fast he's drank or if its actually from the stool that was stuck. Should it be SOLIDS or will it be mush with all that we're giving him to make it come out?
You can see where my Dad's blockage is at this link for reference:
Over the past 3 days he has had a total of 4 bottles of Magnesium Citrate and 9 hours worth (1 dose per hour in 8 ounces water/gatorade) of Miralax. He's been drinking other fluids too and is continuuing his Amoxicillin for his sinus infection as well as other over the counter pain meds. He has had oatmeal, 2 eggs yesterday, but wasn't really that hungry and doesn't think he passed the oatmeal/eggs from yesterday which is no surprise to me as I didn't want him to eat stuff yet. We intend to keep giving him more laxatives specifically the Mag Citrate until the pain is completely gone and his hunger returns.... is that OK ya think?
My question to you is how much laxative product is the MOST you've ever known someone to take or need?
At what point should we stop giving it and take him back to the ER?
He says his pain is mostly gone now, but he still has not regained his hunger and the pain is definitely still there in a mild fashion.
Really appreciated all the info, Searcherr. I realize now I misread how your Dad did at least have an X-ray. So, I'm still surprised the ER people didn't offer more in the way of getting such a large obstruction out of there, and I honestly think he should have had an operation, particularly when they're dealing with someone set in their ways with self-help. There's just so much risk involved in "letting it go," and then a bowel coming apart, and waste getting into the abdomen.
As for your very last sentence, he's probably still somewhat backed up. But from what you describe, it sounds like the clog is INDEED in the large bowel, in which case the enemas might eventually work it through! It can come out as mush, but also eventually harder stuff may come on down that he can pass on his own. If hardened stool does finally make it to the end, and is hard to pass, he can squirt in his backend the ointment "Babylax" by Fleet, two tubes worth, and it will make it easier for him to push it out. If he cries "Uncle," take him to the ER and they'll dig it out by hand. That happened to me one time.
You will know if he has to go back to the ER if he starts vomiting or can't walk or the pain worsens significantly. Maybe check his temperature, keep an eye on his color, pay attention to his state of awareness. If he gets feverish, pale, babbles, take him in. Also, if his colon has begun to get better, you could go back for another Xray, just to see how the clog has progressed. See, if he feels better, but a foot-long clog is still there, they have GOT to do something at the ER. And yes, when I said "admit," I meant putting him in a room, with the idea that his bowel may tear. And if they jump on the same merry-ground about another CAT scan, and he has to be sedated, tell them not to give him the same stuff as last time. Specifically ask for an I.V. for Twilight Sleep.
I don't know of any problems with lots of laxatives for this period of time he is stopped up.
When he finally ends the antibiotics, next day get him drinking that Acidophilus milk or eating the Activia yogurt, keep him on it for two weeks. I can't tell you how important this is to clearing out his guts. It will actually help him, too, with his recurring sinus infections, by returning "good" bacteria to his system. Also, after the antibiotic is done, get him an ordinary saline nose spray, with nothing else in it, and encourage him to squeeze that in his nose whenever it hurts or feels dry or stuffy to him, and it will really help his breathing and keep the nasal passages moist and more comfortable.
See will he eat watermelon or any kind of melon (lots of water in it), ice cream goes down good and doesn't take up much room, Krispey Kreme donuts with milk is good, and so were those eggs you gave him, and 4 oz of orange juice daily is helpful, too.
By the way, I type really fast, which is why I can write all this stuff up so quickly. I'm glad you got something out of all of it, and I appreciated very much you responding. My interest in your Dad's health is very real, and I wanted to help. Hope you guys have a peaceful holiday.
Thanks GG again! I'll be posting back for sure as I leave this page up on one of my tabs in FireFox.
This is the 3rd day and by now he has had 5 Magnesium Citrates over the past 3 days... 2 of them were this morning. He's let out some mush again, but still feels discomfort when he walks. He had the 9 doses over 9 hours of Miralax 2 days ago now and I'm not sure that helped at all. What did seem to help that I noticed was the enema which him and mom are having issues over actually getting done cause of embarrassment and how my mom will not just DO it, but they have to have all kinds of bickering and discussion back and forth the whole time that lands them in a fight. Its absolutely rediculous because the enema is what is going to end this. Though I will keep in mind if he seems stopped up in the descending colon to get that babylax stuff... and/or mineral oil in there.
I have a nurse friend and she suggested putting mineral oil (dunno if ya'll already said that herein; sorry) in the enema and also have him take 6 - 8 ounces orally. She did her herself once (the nurse) because she was having problems too and that 8 ounces had her moving out oil for 3 days.... but it DID WORK to slide her solids out. This and Milk of Magnesia still have not been tried and I want him to do those things today along with the enema..... but I am still dealing with a stubborn semi-old man too.
What do ya'll think of the mineral oil method?
As the graphic I linked ya'll to shows... his blockage is in the ascending colon only or at least it was at the time of Xray 5 days ago now. I also agree about getting another xray done to see whats moved out since all this stuff we've been putting him through. He has been letting stuff out, but I am not sure how much of that has been the drinks and mushy food he's been eating vs the old solids just staying put all this time and the drinks/mushy food going around it.
WE need to get some watery fruits for him to eat. That would be good. Ice cream good too. We have some, but he hasn't thought to eat it yet.
I type really fast too. Thanks again GG and Jaybay!!!!!
STOP with the laxatives! I have been in this situation a couple times already, and after that much mag citrate and laxative, your dad is in more danger from dehydration than constipation.
It is not uncommon to have stool back up in the ascending colon. It makes it very difficult to pass beyond the hepatic curve. Mag citrate works the same way Fleet products and enemas do: the chemicals pull water from the rest of the body and send it to the colon. This results in moisturizing the stool so it can pass - usually in the form of diarrhea. A regular warm water enema will only help if the stool is in the rectum or sigmoid portion of the colon.
You asked earlier about the definition of a bowel movement. That just means anything that passes out of the rectum. It can be in the form of dried up rabbit pellets to very watery diarrhea. As long as stool is getting passed, that's what you need to be concerned with. Everyone is different on bowel habits. For some people, up to 3 times a day is normal; for others like me - every 3 days is normal. It's changes in bowel habits that are concerning - not general frequency.
There is a huge difference between an impacted bowel and an obstructed bowel. Impaction refers to hardened stool anywhere in the large intestine that just doesn't seem to move. This problem is very common - particularly in people who eat a lot of fat and junk and not enough fiber and water. Obstruction refers to something like a twisted section of intestine, scar tissue or even cancer that physically blocks off the flow of waste. With an obstruction, you will generally see a high fever and impressive vomiting. From what you write, your father is dealing with an impaction rather than an obstruction.
Until you get another x-ray to determine the progress of the laxatives, I wouldn't give him any more. He's probably completely cleaned out by now, and won't see any "solids" for a few days. I know from personal experience that it can take several days for the pain of an impaction to go away even when the colon is entirely cleaned out. You have to take it easy with diet and bland foods but things should return to normal. It just doesn't happen overnight.
Hope that helps clarify things a bit. I think your dad will be OK given a few days to recover. :-)
Jaybay - that was a HUGE help in understanding the terms. Thank you very much. I get it now and I'm glad I do. He's definitely got impaction... or had it.
Tonight he let out loads of stuff, but this time he indicated that it smelled extremely bad/foul. This tells me this was the deepest/core stuff thats been staying in there. My mom made him some mashed sweet potatoes and he's been drinking fluids. Like advised anyway he's gonna back off the laxatives for today. I may get him to do the mineral oil tomorrow just to ensure things are final cause I know that oil will last him a few days and hopefully we'll be in the full clear, but I don't intend to have him take any more laxatives for a bit.
I thought the LONG enema with the bag/tube could reach the ascending colon if the person is in the right position?
Yeah, i really want him to go back for another xray. We need a status report of what its doing.
On 12/25/07 Dad ate his first meal since the 19th. He chose Chinese food seeing as they were the only thing open on Christmas Day. He even drove over there. I went with him. He was able to go out and drive after being up for a lil while, but then got very tired after the meal and only ate 1/4 of it all. He was in fact hungry..... as hungry as he's been in 8 days, but still only ate a fraction of what he normally does. I guess this is just his stomach being sensitive after all the laxatives? I wasn't particularly happy at his choice of first food to try after all this mess, but I wasn't gonna tell not to either. Later on he finished the dish after sleeping a while and also ate some crackers and more fluids. No laxatives or enemas today. He had his FIRST REAL movement of solids without aid as well. He's not sure when its from, but I wouldn't think it was the chinese food that came out that fast. I'm thinking his colon was freed up enough to start moving even still residual stool from before. Will be interesting to see if he goes again today without aid 12/26 and if he's regained some energy.
Great news! Sounds like your dad is well on his way to recovery. Don't be alarmed if he doesn't have a BM for another day or two. That's normal after so many days of laxatives. It's just going to take time for him to learn to change his eating habits to a healthier diet. That's a major life change for him and it probably won't happen overnight. If he'll at least take a little daily fiber supplement and watch his water intake, he'll probably never have this problem trouble him again. And at least Chinese food generally has plenty of veggies in it. He could have done a lot worse for his first meal. LOL!
UPDATE: He's still doing well. It seems a biproduct of all this was that during the 8 days he couldn't eat his stomach shrank and this would've been the first time in over 10 years (probably more) that he actually fasted for any duration. He's found he can't eat nearly as much as he was before which is a very good thing though I'm worried over time he's going to force himself to get back to that way. At least he's eating less bread and bm's have returned to normal... maybe even better than normal. He is just about over his sinus infection and started taking his blood pressure medicine again (lisinopril) and we've identified a very aggravating nagging cough that he gets from it daily. He was on verapamil before some months back, but switched to lisinopril cause he was sleeping too much. He still has frequent naps during the day, but not as much now... and now of course he's got the cough that won't go away unless he stops taking the lisinopril as we saw during his colon blockage. It is a dry nagging cough; not a productive one that generates phlegm or anything.
In any case his blockage problem is gone and I'm very very thankful to you two for replying to this thread. You were a huge help in a desperate/scary time. I just hope he does make a lifestyle change as he knows he needs to, but so far I don't see anything changing except that he can't eat as much. He'd mentioned something about the gym in the new year and I plan to go with him if he actually joins. Thanks again !
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