Probiotics after RALP

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laxacharlie
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 5/7/2010 11:56 AM (GMT -6)   
I would like to share a thought about post robotic care. I had very little pure surgical pain post surgery, but some rather astonishing gas pains from my bowel, took several days to subside, even with a liquid diet. Once home, my bowel movements were glacial with some subsisting gas pain. I had a very good conversation with a close friend who has had GI issues for some time as well as experience with surgery (not prostate). He suggested that I immediately procure some probiotic pills and take them as indicated on bottle. These pills are the "good" bacteria naturally occuring in our GI tract. The results were dramatic, I was regular within a day with no gas pains. The issue post surgery is twofold: (1) Antibiotics serve as sort of a neutron bomb in your GI tract, leaving your tract intact but killing off much of the good bacteria so necessary for digestion and (2) Narcotics can cause your GI tract to shut down. The combo can result in a rather uncomfortable situation. I am curious why more docs do not suggest probiotics or activia after surgery? My friend gets on these immediately in the recovery room and reports that the probiotic regimen is most helpful. I am not prescribing this treatment for everyone, but reporting on a situation in which the probiotics helped me, and probably would have saved much discomfort if taken sooner. Any thoughts?

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4831
   Posted 5/7/2010 1:13 PM (GMT -6)   
I didn't have any issues with gas after surgery confused
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/7/2010 2:35 PM (GMT -6)   
Laxacharlie, the pains also come from the fact that a fair amount of air (I believe it's carbon dioxide) is pumped into the abdominal area for a prostatectomy or any abdominal surgery. My sister had horrible gas pains after her hysterectomy but my husband had no pain at all after his prostatectomy. Another issue with constipation after surgery is the narcotics used for pain management - any narcotic will do a number on your intestinal tract. We were cautioned by the surgeon to only use the oxycodene he sent John home with if necessary since any narcotic pain med will do a number on the intestinal tract.

What your friend said about the antibiotics makes great sense - all bacteria (good and bad) are attacked which upsets the natural balance.

Glad you found quick relief from your pain.
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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/7/2010 3:29 PM (GMT -6)   
Remember those two bottles of stuff you drank the night before ? That's where the bacteria went, not the anesthetic. It just puts your colon to sleep also.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


bb48
Regular Member


Date Joined Mar 2008
Total Posts : 23
   Posted 5/8/2010 8:59 AM (GMT -6)   
 
 
   After DaVinci surgery I had agonizing sporadic pain that they couldn't control with anything. Just be sitting there feeling fine then it was like someone stuck a knife in my gut. I spent most of my time in the fetal position trying not to move. After the third day a new nurse came in and asked if I'd been walking around, I obviously had gas pain. Because the nursing staff was shorthanded nobody had offered to walk with me or inform me I might have gas pain, (they wouldn't let me walk by myself because I was in such pain, duhh--). My kids came in and started hauling  me up and down the corridors, and within a couple hours I was feeling 100% better. On the fourth day right before discharge, one of the attending doctors told me they had to apply a higher CO2 pressure during the surgery because of an existing hernia patch and my musculature, and that was the source of my "discomfort". Gee, thanks for the info Doc!
     I got an added "gift" from the hospital, a c-difficle infection that it took my doctors two weeks to diagnose. When I asked, after a week at home, if it was normal to be having a bowel movement every 45 minutes, I was told that temporary irregularity is sometimes a side effect. After two and a half weeks I had the catheter removed, the infection was controlled and I felt like I was walking out of a Turkish prison when I left the doctor's office. And, yes the probiotics are a necessity to get things back in balance.
   I've had several extended hospital stays in my life (all orthoapedic except for the PCA surgery). I could write a book about some of the crazy (and funny looking back at it now) things that have happened all because I was ignorant, or trusted hospitals, doctors and nurses, to do the right thing at the right time. You HAVE to do everything you can to educate yourself BEFORE surgery. Take some responsibility for your care if you don't think things are going right. If I had discovered this website before my surgery I am convinced my recovery experienc would have been totally different.
   Thanks for letting me rant, I feel so much better now.
Age 59
Robotic prostatectomy 2-4-08, Shands U of Fla
PSA 6.1, Gleason 3+3, 1 out of 14 biopsies pos. 5%
Negative margins, surgery went well.


laxacharlie
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 5/8/2010 9:37 AM (GMT -6)   
Hi, goodlife
Just to clarify: the narcotics put your colon to sleep and this can result in a common condition which can result in increased gas pain. True they do not kill bacteria...but the antibiotics do kill off good bacteria and many GI specialists recognize this. The combination can create a rather monumental as buildup, totally unrelated to the C02 put into your peritoneal cavity(which can also be painful). No doubt the day before prep also ushers out lots of the good bacteria. I know in my case the probiotics provided very quick relief and I wonder if they would have helped had I taken them immediately post surgery. A GI specialist in Santa Barbara suggested this would have been beneficial, yet many surgeons do not focus on this. IMHO, this is worth considering after surgery.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/8/2010 10:51 AM (GMT -6)   
Charle,

I don't disagree. At Cleveland Clinic, you can't go home home until you pass gas, and a BM, and you saty on clear liquids. Some places seem to kick you out as soon as possible regardless of your bowel status.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 5/8/2010 1:55 PM (GMT -6)   
I had terrible pains from the gas they pumped into my abdomen during surgery - took 2-3 days of walking a lot to get rid of it. I was told to take antibiotics for 10 days - so I took probiotics after that to rebuild the good bacteria in my system that the anti-biotics kill. I have often wondered why Doctors and Hopspitals don't recommend that??? I am now wondering if I should take some during and after radiation. Does the radiation kill the good bacteria in your intestines??
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16
SRT begins May 3, 2010
 
 


laxacharlie
New Member


Date Joined Apr 2010
Total Posts : 16
   Posted 5/8/2010 3:42 PM (GMT -6)   
Tim-from-Maine
Excellent question, perhaps a good idea to ask doc., although many do not have expertise outside of their specialty. I am astounded that more docs and hospitals do not recommend probiotics. Am curious -did taking probiotics help you. Again, my results were very noticeable.

Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 5/8/2010 3:54 PM (GMT -6)   
I think they helped - although not as dramatically as for you. I think your system recovers eventually without them - but people who take antibiotics and jump start their immune system by suing them - or at least eating yogurt.
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16
SRT begins May 3, 2010
 
 


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 5/8/2010 4:57 PM (GMT -6)   
I remember I had gas passing for 4 days before "Lunch' finally arrived.

But, now it occurs to me that when the Doc OK'd me for a meal on the day after surgery at the hospital I had wolfed down mashed potatoes, chicken, rolls, jello and beans!! Probably not such a great idea (after I got home I was doing mostly liquids and fruit). No doubt the damage had been done and that logjam just slowly wound its way thru the intestines.

So, if the Doc says OK to eat .. pick something soft and soupy and mushy!
Age 59, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery ,Nerve sparing, 1 day in hospital.
02/18/09 Cath out -- passed 1 cm oblong bladder stone (not kidney!).
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
04/09, 07/09, 10/09, 01/15/10 PSA <0.1
03/2009 Levitra@20mg / Viagra@100mg/Cialis@20mg -- (nocturnal stirrings started 02-03/2010).
08/09-09/09,02-03/10 MUSE@1000mcg 80-90% (with some ache )
10/09-11/09 TrimixGel@(500/300/100mcg): 60,70,80%,
02/10-03/10 TrimixGel@1000/300/100mcg - 80-90% - just @ usefulness.
Gel + MUSE 500mcg -- 100% for 30-60 mins and 80-90% for hours after that).


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 5/9/2010 3:34 AM (GMT -6)   
I'm sorry you guys have had this pain.
I didn't have to eat differently I was even allowed breakfast the morning of my op and had a BM 48 hours after the op once I was home again.
I was told beforehand that I must walk a lot to prevent things hurting and I did so. Including walking up three flights of stairs to my appartment the day after the op.

Gas pain inside the guts can defintely be dealt with by diet and excercise. But when i was given pain meds in hospital I was also given another med to protect the lining of my gut from the pain med!

I was also told that the CO2 would cause pain in the shoulders not the abdomen. I think abdomen pain can be caused by the skin getting stretched by the gas during the op and not by gas getting left behind afterwards. What pain I did have was in a very small area around the large incision above my navel and was said to be due to the trauma ie neither gas nor guts but the cuts.

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)

Post Edited (English Alf) : 5/9/2010 2:59:14 AM (GMT-6)


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 5/9/2010 9:10 AM (GMT -6)   
Laxacharlie
Great idea! Between the enemas, colon flush, antibiotics and yes, the complete shutdown of systolic action of the bowels during surgery is a nuclear meltdown for the whole system. I think the reason docs don't do the probiotic thing is that they simply don't think of it, and there probably has not been a study in the NEJM about it!
Thanks for pointing out that the CO2 in the abdomen is totally and completely separate from the gas pains in the intestines. A lot of people confuse the two. The passing gas thing is the first sign that indeed, your bowels are beginning to function. That alone causes pain. The CO2 in the abdomen can also cause pain, but it just has to be absorbed into the blood system.
Good idea, good thread.
Paul
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

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