Obstruction Anniversary Visit to the Hospital

We're back in the hospital for another bowel obstruction. Our last visit for a bowel obstruction was almost exactly one year ago, January 10th of 2017. After reading last year's post, I can only assume they no longer have you drink the contrast before a CT scan. I can understand the potential issues in drinking something like that when you're already backed up, but it's disappointing to us because the contrast itself seems to have resolved blockages in the past. We've even joked about getting some to go - and between you and me, that was really more of a question everyone laughed at, than a joke.

Before all this started, Karen caught some kind of stomach bug. We don't think it was the flu because she never had much of a fever. We checked often but I don't believe we ever saw her temp go above 98.9°F. She did however have diarrhea. Taking imodium to control diarrhea has preceded blockages multiple times in the past; so this time we decided to just skip her usual bowel maintenance regimen. This has slowly grown over the years to accommodate the increasing amounts of opiate based pain medication. It includes senna, colace, bisacodyl, and if things start to slow down, lactulose. Even skipping all these laxatives, it took a week for things to calm down. To the best of our knowledge there was no time between the diarrhea and the constipation. Just one day things were moving too quickly, and the next she had no bowel movements.

She developed abdominal pain and bloating and we decided this may be the start of a bowel obstruction. So along with jumping full speed back into our regular laxatives, we switched to a liquid diet. That was the 9th. By the 10th the pain and bloating had gone away and we were pleased we had caught it in time. There had still been no bowel movements and by the 11th the symptoms started to return. Karen's pain level spiked later in the day on the 12th and we went into the ER. The hospital waiting room was packed, but I guess Karen gets VIP treatment now, as we quickly got a room. Shortly after, a CT scan confirmed it was a bowel obstruction.

Although we haven't forgotten in the least, one of the doctors wanted to remind us that Karen has a frozen abdomen and no surgery would be possible. (I explained it here last time.) Which means we basically just have to wait and see if it resolves on its own - and if not, they can place a permanent venting tube and send Karen home one last time. Our obstructions have always resolved on their own in the past, but it's a stressful situation. And any deviation from our past blockages makes me nervous.

Normally obstructions are accompanied by intense nausea, and while Karen did puke on the way in, it wasn't preceded or followed by any nausea. The pain was bad, but seemed to go away extremely fast after the NG tube went in. Perhaps her ever increasing fentanyl dosage helped mask some of that pain, but I can't explain the lack of nausea. This is also the first time we're constantly having trouble getting stomach fluid out of the NG tube. While in the ER, the initial NG tube was removed and replaced with a larger tube, but we're still having issues. It seems they have to flush the tube every hour or two. I worry the tube went in too far and it's just pressed up against the bottom of her stomach and that's why it can't suck anything out. Both the nurse and doctor felt the position was good; so what are the odds both of them got this wrong? I guess the other possibility is just her stomach is already empty due to our two day jump start of a liquid diet at home, but everyone thinks they'd see less distension if this were the case. This is important to get right, as part of what allows blockages to reverse is the lack of pressure upstream.