Bowel Obstruction & Ca. of Bladder

gwenith, BSN, RN · Mar 29, 2004

Jay Jay (((((((((((hugs))))))))))))) so sorry that you both have to be going through all of this.

suzanne4, RN · Mar 29, 2004

Jay-Jay:

So sorry that you and your husband are having to go through all of this.

My thoughts are with you.............................

jnette, ASN, EMT-I · Mar 29, 2004

Oh Jay-Jay... you sure have had to go through so very much lately.

(((HUGS)))

I really don't have an answer, but I do send warmest hugs and energizer bunnies your way. I know you must be frazzled physically and emotionally.

I'm so very sorry about your DH, and pray that he remains painfree as much as is possible. Be kind to yourself, and to one another. He's so fortunate to have you there by his side.

leslie :-D · Mar 30, 2004

jane,

what were your husband's pseudo bowel obstructions related to? i can understand the etiology w/late stage prostate, only because of the proximity of the prostate to the rectum. i've never heard about it w/bladder ca and is typically contained to the gu system. the s/s i've read are revolved around hematuria....i'll be glad to do any sort of research for you. please let me know.

**canoehead, BSN, RN** · Mar 30, 2004

You know Jane, every time I come onto this board you have been hit with something else to cope with. I don't know how you are doing it, but you sure sound sane and together. Wish I had the expertise to make something about this illness easier for you.

I keep hoping for some good news, and my love is coming your way.

Tweety, BSN, RN · Mar 30, 2004

Sorry to hear that Jay-Jay. Best wishes.

Jay-Jay, RN · Mar 31, 2004

Thank you all for your good wishes! :) Your support and kindness is very much appreciated.

Tina, I really, really wish I COULD give you some good news, but the long and the short of it is, I think my husband is going to die. He has gone from 190 lbs. on January 27, when he suffered the stroke to 145 lbs. He has NO appetite to speak of. Eating makes him nauseated. They've done all sorts of tests and scans, and cannot find a cause. His total intake tonight was 1 small plastic container of jello, plus a bit of pineapple juice (he's taking fluids okay, but HATES Ensure, Resource, etc.) If this keeps up, and it's been this way for a number of weeks, he is not going to survive.

Now, in my nursing experience, I've only discovered two things that can cause this severe a loss of appetite. One is cancer, with a bowel obstruction, and the other is terminal kidney failure. His creatinine and urea have gone back to normal since the bladder hemorhage stopped. What else could it be?? :confused: :scrying:

Jay-Jay, RN · Mar 31, 2004

Earle, to answer your question, the way the doctor explained it, a pseudo-obstruction happens because the person gets so sick that the bowel just shuts down. I guess peristalsis temporarily stops, creating the same symptoms as a physical obstruction.

CCU NRS · Mar 31, 2004

Sorry to hear about your problems and my prayers go out for you and DH.

Question what is his age and how long has the Dx been know?

If the bowel has not shut down he could recive Tube feeds and if so he could recieve Hyperal or TPN is he currently hospitalized?

Bladder CA can mets, this is why something should be done fairly quickly do you have a good uroligist? A bladder removal with urostomy or faux bladder. They have bladder implants now and there has always been urosotmy. If he is still farily young and in otherwise decent health. You do not want it to reacha a kidney failure level. also if it mets to lung or bowel you will be in real dire straights.

DMB FAN2 · Mar 31, 2004

Hi Jane- I first would like to say that I am sorry for your husband's suffering....he is very lucky to have you......also I thought that I would put in my two cents for what it's worth....I work as a Hospice nurse, and when I have someone that has a suspected obstruction, and they wish to stay home and out of the hospital....we use a drug called Octreotide(sandostatin) which relieves the pressure and draws the water from the bowel....I have found that it works excellent in the patients that I have had....and it will stop the vomiting. I have used 200 mcg, sq, q8h....so that may be worth a try.....

Also...is he not having aggressive tx at this time? If not then Hospice care may be able to help with the symptom control and comfort care.....

I will keep you in my prayers and feel free to PM me for anything.....Best Wishes :kiss

Jay-Jay, RN · Mar 31, 2004

Okay, guess I'd better give the whole long story here...

Roger has been having heart problems (a-fib, angina) for a number of months now. He finally consented to have an angiogram done in late January. They took him off his coumadin, never thought to give fragmin as insurance against blood clots. The day after the angiogram he suffered a stroke. He was in hospital for nearly a month, did quite well in rehab. He was home for about 3 weeks. His appetite wasn't great, and steadily got worse. His last week home, his intake dwindled to almost nil, and he started to hemhorrage into the bladder. He's been having ongoing problems with incontinence and UTI's for a couple of years now, and has been followed fairly closely by a urologist. While in hospital, he had some slight bleeding, which they said was due to coumadin (INR was high) but they put him on Cipro 'just in case.'

Anyway, this was a really gross hemhorrage, with huge blood clots, which progressed to total urinary retention. (Hemoglobin dropped from 150 to 109 in the space of 8 days!) They had to wait for the bleeding to subside before they could do a cysto on him. The same day the cysto was scheduled, he went into a bowel obstruction. So, they anethetized him, scoped the bladder AND bowel, and found....nothing. Just a lot of inflammation in the bladder. CT scan showed constriction of the left ureter where it joins bladder, and 3 lesions in the R kidney, two of which may be cysts.

After the anesthetic, he aspirated, went into a-fib, and had a small MI, followed by an episode of pneumonia and CHF. They were just nicely getting THAT cured, when he had bowel obstruction #2.

So, needless to say, they are reluctant to try anything else until his health improves a bit. Latest x-ray shows some lingering pneumonia in both lungs. Meanwhile, the urologist is away, and doesn't come back until Thursday. I could get another urologist to look at him, but the poor man's been through SO much, I figure a few more days isn't going to hurt. If ONLY his appetite would improve!