Is it just neuropathy?

[joenurse]

I am currently working with a patient who is male 45 quadriplegic C6 spinal injury about 15 years ago.  He has been having severe stomach pain for the past year.  He is having trouble passing bowel and becomes severely impacted before bowel is forced out.  Bowel routines are regular but not producing regular bowel movements.  Patient complains of severe stomach pain on the left side, also left side becomes stiff after ten days without bowel movements with stomach distention.  Doctor has evaluated him and states that pain is due to neuropathy and has not completed ultra sounds or any other tests.  Patient is on morphine, baclofen, diazepam, lorazepam, ducacete, lactelose, senna, prn oxycodone, iron, vitamin d &c, protein shake, and other drugs.  Should we continue to accept the diagnosis of neuropathy for his continued pain? He has a previous history of infection due to super pubic catheter.  No infection at current date.

[ggreg]

Well, the patient's pain might be from neuropathy on top of everything else, but what you're describing sounds exactly like constipation, which you indeed said he got empacted, and it happens to patients who spend a lot of time laying down (exercise helps bowels move better), OR patients who take certain medicines and supplements.  For me, I had the same thing happen to me when I busted my back in a wreck and had to lay still for two months, I got empacted the same way, twice.  I was on Demerol.  I've also had the same thing happen to me a number of times over all my ensuing years, and I can usually couple the constipation with meds and supplements.  I might add that severe constipation can damage a bowel, to where it won't work right, so that's something a gastroenterologist can check into if the below suggestions don't help.

Here's what he's taking that will cause constipation, any single one or a combination:
Morphine
Oxycodone
Iron

I have no idea why he's on both morphine and oxycodone, the oxy is the last thing he should take to sleep, but if one's going to be eliminated, then a very slow tapering off the oxycodone would probably be the one medicine he would miss the least.  (I wish I MYSELF had morphine!)  Also, while he may be iron-deficient, that can be replaced through correct nutrition and thus he might not need the iron, which causes constipation...just ordinary vitamins with iron can clog up a regular person.  

Now, if he gets down to just Morphine, he also needs to drink about five glasses of water daily as a regular habit, and his physical therapy should include lots of moving of his legs.  I also recall when I was in the hospital, I was given I think a suppository laxitive, helped restore my normal digestion.  There's also over-the-counter ointment laxatives that can be squirt in there whenever he has the urge to go, allows large waste to come out easier.

It is not fair to this man that he has to get so constipated that it turns his large bowel into one solid mass, in fact it's negligence that the docs are not addressing the sitution in an organized and proactive way.  No wonder he is painful in the descending part of his bowel, plus he has to endure bloating.  An ordinary plane black & white X-ray will show all the waste piled up in his large intestine.  His tendency to get blockages has got to be regularly attended to by doc's orders to nurses with any one of many solutions, including enemas, the rectal laxatives I mentioned, moving his legs daily.  In other words, they shouldn't just let it build up and then try to get it out.  And his medications need to be reviewed for their potential to dry out waste and then block up the bowel.

By the way, although this doesn't relate to his constipation, there is no need for him to be on both diazepam and lorazepam.  Diazepam is sufficient, and I might mention that while the benzos don't dry out a person the way opiates will, it can make a person a little thirsty, thus all the more reason to keep up with his water intake.  Oh, one more thing, if he's drinking tons of juices, that has to be monitored, because too much can dry out a person, too.  Well, I think that covers it.  Very good of you to inquire about this patient's situation, because the solutions are basic health care 101.

[caregiver222]

As ggreg states, the administration of morphone and oxycodone will paralyze the intestine, end peristalsis, and do little for the pain.  *** ggreg stated, the solutions are basic health care 101. Right now you have a drug-addicted patient whose problems are related to his medications. I would suggest a change in primary care physicians. On the other side of the coin, many physicians, faced with such a patient, will prescribe narcotics even though they are medically inappropriate, for reasons that should be obvious. There is a treatment for the conspitation if he gets off the morphine, invented by Nikoli Tesla in 1894. His machine produced souind vibrations which stimulated bowel movement and evacuation without use of medication.

[caregiver222]

Those three stars in my last post do not mean I insulted you ggreg. It means I typed the word "as" and the keyboard stuck and added an extra "s".  Well, I've got a patch over one eye so I have an excuse.