Help with Constipation...

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gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/1/2010 5:57 AM (GMT -6)   
Hi all, my father finally started radiation treatment last week, but the chemo he was scheduled to also get, as part of the study, has been put on hold, due to the fact that he still has a foley, and in fact the bleeding won't stop (presumably his prostate is bleeding), so lots of blood clots and irrigations of the catheter, not fun, and he is an inpatient in the hospital now due to all the pain and irrigations required of clots in the catheter.... They were worried that chemo would increase the chance of a dangerous infection.

Anyway, the latest challenge now is that he can't move his bowels. I think the idea is that his prostate is so large that it is pushing on and closing the rectum. They've had him on lactulose for about a week, as well as suppositories, tried fleet enemas, etc. it ain't moving.
When he tries to have a bowel movement, the pushing causes even more bleeding to come out of the catheter, and usually a bladder spasm as well (followed by a needed irrigation to remove blood clots out of the catheter...).
Really horrible, he's in a huge amount of pain now from this.

Is there anything else that can be tried to clear the bowels? The nurses don't have any suggestions, and the Dr's don't really come around that often on rounds, and the visits are quick...
Is there some other formula more powerful than lactulose, that they use before someone has a colonoscopy, etc??

My father is really ready to give up now. Chemo cancelled, in constant horrible pain from being blocked, and from the usual prostate pain. Things are really not going well.
And I don't even know what the eventual plan is for the size of his prostate, since some Dr's have indicated that radiation won't shrink it (and will in fact do just the opposite for a time)...
Help!
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Casodex for last two weeks of November '09, then Lupron.
Scheduled to start IMRT and Taxotere March 25 2010.


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 4/1/2010 6:17 AM (GMT -6)   
Not sure if I will be of any help but they could try the pills that we take before a lower GI. Or the liquid that we had to drink. Fleet should work though. If impacted they my need to dig it out.

Sorry to be so blunt.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/1/2010 6:19 AM (GMT -6)   
Gibson, when we met with a rad onc this past summer, she told us to use Metamucil, which helps with both "going too much" and "not going."

Before a colonoscopy, the "cleansing" process is intense and produces severe diarhea and can dehydrate...don't think you'd want your dad to go through that. just had one in January and I had to take 2 laxative tablets plus drink a whole bottle of citrate something...talk about cleaning out the old pipes! Has your dad tried stool softeners to help ease the pressure?
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/1/2010 6:29 AM (GMT -6)   
I think they've tried just about everything. Yes, he is on stool softeners every day, lactulose (3 times a day I think), fleet enemas, etc.

The nurses kind of indicated the same as you, that the bowel cleanse was harsh.......but geez, that's gotta be better than the intense pain he is going through now, no?! And at a certain point, doesn't it get dangerous to be blocked for so long?

I think he would gladly trade what he is going through now for bad diarrhea..

What is the difference between Lactulose and Magnesium Citrate?
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Casodex for last two weeks of November '09, then Lupron.
Scheduled to start IMRT and Taxotere March 25 2010.

Post Edited (gibson00) : 4/1/2010 6:33:08 AM (GMT-6)


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 4/1/2010 7:01 AM (GMT -6)   
Gibson, If at all possible you need to talk with the Dr. He should be able to resolve the problem.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/1/2010 7:30 AM (GMT -6)   
There is always the "Go Lightly" method, I have never known that not to work, and if anything, it works too well. Your father's conditon and pain sound serious enough for the doctor to make a point of staying with him and dealing with his issues. I would be hopping mad until a resolution could be found. I feel for him.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 4/1/2010 7:38 AM (GMT -6)   
I think that this is the time for you to become an active advocate for your father. You need to talk to his doctor immediately. Stand at the nursing station and keep repeating "I must talk to his doctor NOW" in a firm voice -- don't be put off by a "he'll cal you later." Keep your cool, but make it clear that you aren't going anywhere without talking to the doctor. They will probably try to fob off a resident on you, but if he does not order immediate treatment, tell him he needs to call the attending physician immediately -- right from there.

Your second line of approach, should the first not work, is to go to the administrative office of the hospital. Tell them that your father is not receiving adequate care and that you wish to file a formal complaint and to talk to the official (not a secretary) in charge of receiving such complaints. Again, calm but forceful, and be clear that you are prepared to stand in the office and attempt to present you case to any "suit" that seems to work there.

It is always good to take notes -- names and times -- it gets people's attention. Introduce yourself, give your father's name and ask then for theirs.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/1/2010 7:42 AM (GMT -6)   
Well, just got a call....FINALLY...as in 5 minutes ago, they managed to get a bowel movement. I'm not sure what method they used, but something got it moving. They said what came out was very hard. I'm assuming they may continue him on lactulose? Not sure. But I'm thinking I need to get him drinking a -lot- of water. Perhaps with some metamucil mixed in?? Don't want him getting blocked again!!

He was -very- groggy when I just spoke to him, as they have him on 21mg Dilaudid Contin twice a day along with a 3mg dilaudid breakthru shot every 1- 2 hours, but said he felt a million times better than this morning. He was truly wanting to end it all this morning..

Very very very frustrating, in that on the bright side, he has finally started radiation treatment, and if anything , they said the planning MRI for the radiation showed that the tumor appeared to have -slightly- shrunk (at least it didn't grow!) after 3 months of Lupron.....But all these other problems, the catheters, bleeding, pain, the delay (or complete cancelation of) of chemo....

The latest is that his testicles are quite swollen (but not painful). The nurse felt it was from laying in bed and being on IV. I've emailed his Dr to ask about it...

I'm so stressed out and tired...
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Casodex for last two weeks of November '09, then Lupron.
Scheduled to start IMRT and Taxotere March 25 2010.

Post Edited (gibson00) : 4/1/2010 7:48:24 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/1/2010 7:54 AM (GMT -6)   
Thrilled to read of some improvement to your dad. I know he's not out of the woods yet, but at least that was a positive direction. I hope and pray that he continues to pull ahead in his battle. You need to get some mental rest yourself, take a breather for you.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 4/1/2010 10:00 AM (GMT -6)   
Glad to here we have a step forward. Do keep us posted.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 4/1/2010 11:13 AM (GMT -6)   
Most of the guys on the radiation sites swear by metamucil. I took it during my treatments and still take it daily.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/1/2010 11:18 AM (GMT -6)   
Thanks all. The chemo Dr met with him today, and basically still will not give him chemo in his current state. She says she's never treated someone with PCa that was in such bad shape. It seems it is mostly related to the sheer size of his prostate (I think it was something like 8cm x 6cm....) pushing out on everything and bleeding, which, again, causes constant blood clots in the cathetar requiring painful irrigations. The odd time the bleeding stops, as soon as he tries to get up and or use the toilet, the bleeding starts again.
We were hoping urology would do some sort of scope and perhaps burn anything they saw bleeding, but hasn't happened...
Just not sure what to do. As far as I know, radiation alone will not shrink this, will it? :(
...
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Foley Catheter
Casodex for last two weeks of November '09, then Lupron.
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
Started IMRT March 25th, Chemo on hold due to catheter bleeding issues, etc.


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 4/1/2010 2:19 PM (GMT -6)   
Gibson:
Sorry to hear your Dad is in such rough shape - but he seems to have an angel on his shoulder ( that's you !) protecting him as much as you can.
When I broke my upper leg years 12 years ago , I was not able to have a bowel movement for a week after surgery. Nothing helped. It was a nurse who gave me her family recipe to get the bowels moving again.

In a regular (but microwaveable) 10 oz glass - mix 4 oz of prune juice and 4 oz. of milk - microwave that mixture for one(1) minute - let it cool enough if necessary so not to burn - and have Dad drink it all down .

It sounds awful but doesn't taste too bad - in 10 - 20 minutes - I felt the urge for a B.M. ( not a panic urge) and was able to have a cleansing B.M.
Check with his doctor if that is ok with him - for safety sake. I have used that mixture a number of times when I have been ill and constipated. I even had that combo ready when I came home from my open RP surgery - but found the regular metamucil and stool softener was fine enough.

Wishing you and your Dad all the best and a good recovery for him. If you can , (as stated by others) be present when he is questioned by, or questioning, the next round of treatments - 4 eyes and 4 ears and a notepad and pen does wonders !!
:)
hugs,
BRONSON
.................
Age: 54 - gay - with common-law spouse of 13 years, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010
............

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