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Re: Bladder cancer, intestinal blockage

Posted By HFHS M.D.-MS on March 20, 1998 at 17:52:47:

In Reply to: Bladder cancer, intestinal blockage posted by Laura on March 20, 1998 at 04:07:19:

: My Dad was diagnosed with bladder cancer early February, underwent surgery to remove the bladder (and anything else not nailed down, i.e, lymph nodes, appendix, prostrate). He recovered ok from the surgery, except they had to give him enema to get intestines going again after about 5 days. He was released on a Friday but my Monday, could not eat, nauseated, bloated and no b.m's or gas passed.  He was admitted back to the hospital on 3/2 and is still there. Still no significant b.m.'s or gas passed. Has nasal tube, with long orange tube (I think 15 feet) feeding down to intestines to hopefully find blockage. Never stopped. Seemed to help with a couple small b.m.'s, but none for a few days again.
They have done many, many x-rays, sonogram (like for pregnant moms) and now just did a catscan, to find nothing. They can not see an "adhesion", blockage, loop, anything.
To top it off now he has 102.5 fever (from what they don't know... more blood tests...), he had a strange lump in his arm above the i.v. pick (so they moved it and that seems to have helped), constant hiccups now, and he developed a yeast infection in his stoma (I think from all the antibiotics they have pumped in). His throat is also extremely sore due to the tube.  To put it bluntly, which I did to his doctor today, he is even worse today than he was 2 1/2 weeks ago when he went back in.
Now they want to do some white blood cell test to see if they gather up in an infected area, and another sonogram tomorrow (wrong word, but you know what I mean...)
I am extremely frustrated and upset to see my father continuing to deteriorate and lose his incredible patience and will to get better. Because this whole ordeal has been going on for a month, and he has had no food, and little drink by mouth in that time (he's lost 25 pounds) he has lost all sense of humor and hope of ever passing gas like a normal person again!
They think it is time to go back in and see what is wrong. What do you think? Should I try to get him another opinion? The nurses I talk to like his doctors, and I know they usually know the good from the bad. But, I'm afraid if something positive doesn't happen soon, he will slip off to a depression so that he doesn't even want to get well.
He's very afraid that they will go in, mess with the intestine, and end up on a colostomy also - he says he can deal with the pee-bag, but not a poop-bag!! (He refers to the lady that changes his bag, as the "bag lady")
Please give me some advice on this situation. I just feel like these doctors are just grasping at straws, and have no idea in heck what they are doing!
Thank you so much for your quick response, and I'm sorry this is soooo long!

Dear Laura
Sounds like you and your father have had a tough go of it.
It is good that you are taking an interest in your fathers care and are there for moral support when he needs you the most.  
As a doctor, I know difficult it is to keep the communication lines open with family members and patients especially over long periods of time when things are not going well.  It is frustrating for the doctor when he does not have  the answers either.  
With regards to your fathers case there are two common things that must be considered.  One is a blockage and the other is called ileus.  The blockage, if caused by scar  tissue  has about a 2/3 chance of resolving itself with time and tube suctioning which decompresses the gut.    If the bowels do not become unkinked, or if a tumor is causing the blockage,  surgery will be necessary.  The surgery after this long period of illness has increased risks.  Your fathers ability to tolerate the anesthetic and heal wounds is probably reduced, but if an obstruction becomes apparent or an abscess is located, this may become necessary.  If he does need a colostomy it is probably temporary.  Usually the reverse the colostomy in 6 months.  The other possibility is an ileus or lazy intestines.  The bowel becomes lazy when handled during surgery, or in patients who take lots of narcotics.  Another cause of an ileus is an abnormal level of electrolytes (salts) in the body including calcium or magnesium.  The ileus can be prolonged in some patients ( 2-4 wks. or so).  Surgery will not correct this.  Lots of walking, tube decompression, correcting metabolic abnormalities  and waiting are parts of the treatment.    The doctors have the advantage of the xray findings and will be able to shed more light one which, if any of the above are probably causing the problem.  You can probably understand now why they seem like they are taking their time before they are sure.  The treatment of these conditions are completely different.  It sounds like they are using their entire arsenal to find out what is wrong if they are getting a tagged white cell scan.    
A negative CT scan is encouraging that there is no pus pockets which would require drainage.   If your father truly is not tolerating food, and has loss 25 pound of true body weight, discuss with your doctors the possibly of  total parenteral nutrition(nutrition through the IV). You did not mention the final pathologic stage of the bladder tumor after surgery. Was it all contained in the bladder or had it spread elsewhere to lymph nodes etc.?  This information will greatly affect his prognosis.
He still sound like he has some humor left if he can joke about the bag lady.
If you become dissatisfied with your care you are welcome to seek further medical attention at Henry Ford Hospital.   If interested please call 1-800-653-6568.  We can also arrange local accommodations through this number if this is your need. Please bring any physicians notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Hope this has helped.  
* Keyword: Ileus after cystectomy, Bowel obstruction after cystectomy

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