Tuesday, July 7, 2009

Bowel Me Over

Pain medication can bring blessed peace. Like the calming sensation of a warm bath stroking your neurons, soothing your synapses, cooling your brain. It’s a cancer patient’s indispensable sidekick. But it also has another less desirable effect, the cure for which Jamie Lee Curtis chirps about with irritating “regularity” – constipation!

There is unsettling about the oncology nurse’s inquisition when it goes from “are you in pain?”, (of course, and it’s either from the cancer or the treatment!) to “when did you last go to the bathroom?” The question seems out of place, a brain fart almost. But, without batting an eye, you answer “yesterday,” or “three weeks, two days and five hours ago,” and groan.

Suppositories, enemas both water and mineral oil, Senna tablets, Docusil, Milk-of-Magnesia (where is ‘Magnesia’?), magnesium citrate are the OTC (over the counter) remedies and it’s up to you to find the right balance. But sometimes another drug or treatment conspires with the pain meds to ambush your best defenses, and then you get an impacted bowel, as I did a few weeks ago. I’d rather call it a painfully immovable, over-stuffed sausage angrily meditating above your groin.

Admittedly, we were slow to ask the right person for the OTC cure so we threw suppositories and water enemas up there like shoppers at a Prada sale. I consumed the oral options too but the angry Buddha had shut down my entire gastric system, so they came back rather quickly. The answer turned out to be mineral oil enemas. Days later I was back chirping with Jamie Lee.

Of course anyone with half a brain is asking themselves, “why didn’t he speak to a gastroenterologist?” Well I tried. First my old GI didn’t take my insurance anymore and I hadn’t developed the sort of doctor – patient relationship with him that enabled a quick email or call (more on the vital importance of this in another post.) So then I asked both my primary doctor and my Chemo doctor, both of whom recommended a visit to the emergency room if it continued – a very expensive option that vacuums time like nothing else in the world. So I set about getting an appointment with a new GI.

Visiting a new specialist doctor, in New York City at least, is like landing on an orbiting planet – you have to wait for months for an opening. Call after call resulted in, “are you a current patient? No? He can see you just before hell freezes” or words to that effect. Frustrated, I emailed my oncologist for help. A week later I was sitting in the GI’s waiting room and since my crisis had ‘passed’, I was there for a general plumbing check.

In walked nattily dressed Doctor X carrying my freshly minted chart. He asked for my problem. I put my speaking valve on my tracheotomy and explained, in my difficult to understand voice, what had happened. As I was talking, he was reading my chart - this unnerves me because it’s like driving and talking on the cell phone, you don’t have undivided attention. He read my Medical History (written and printed at home, it’s an invaluable one page, medical summary that includes a medication list - saving a great deal of time with doctors’ and hospitals’ forms.) He expertly prodded my belly, announced I no longer had the impaction, and prescribed a drug and a colonoscopy, saying, “my assistant will arrange that with you for next week.” I didn’t bother with a peevish “I told you already it was gone,” but did reminded him that I get nausea for a week after each chemo dose, so it might be better for me to try to chug the reservoir of liquid required during my week off. Then he was out the door.

This all sounds proper. BUT, and this is my biggest concern with doctors today, I never really had his attention. He said all the right things but didn’t respond to the individual variations of my case. Later I found the medication doubled my chemo’s nausea and it wasn’t necessary since I was no longer impacted by the impaction. This sort of half-wittedness may just be the result of insurance income pressure. Many doctors today leave 15 minutes per patient or less, to keep up the frequency of reimbursements or just because they want to serve as many as possible. But that is not the doctor for my colonoscopy.

Here ends the blog on bowels and consternation. Thanks for reading and have a great day…after all the cats are happy with this great weather!

“I am Sir Brian, as bold as a lion!
Take that! – and that! – and that!”


  1. Sweet Brian - I hear you. Our medical system sucks! It sucks so much that I feel like leaving it very frequently. But. Please allow me to play a role as on-call nurse, as needed. I don't pretend to have all the answers to the issues you are or will be dealing with. But I actually could have helped with the above ordeal. And I would be so so happy to use some of this education I'll be paying off until I'm 66 with you.
    And your writing is wonderful by the way.

  2. Brian -- lovely writing, thank you!

    All the best, Moira (Diane's friend)

  3. Thanks for doing this, Brian. We have similar issues in our family with someone who has a painful autoimmune disease and who has been disfigured by Secondary Cushings Disease.

    You are "right on the money" -- honest and somehow despite your reaction to the cable guy --able to balance the anger with refreshing humor. Hope you keep this one going.

    We deal with life and sickness and perfidy and the life around us on a tumblr microblog at
    if you ever want to visit the other end of our state (North Tonawanda, New York)

    Best wishes to you in your efforts to make each day as good as it can be,

  4. If it helps, my gastroenterologist was lovely and fast with appointments and thoughtful and paid attention:
    Hon-Min Eng, MD
    137 Fifth Avenue @ 20th Stree, NYC

  5. thank you for sharing with us your experiences -- i hope many health care providers would learn from what you write about.

    I was a hospice nurse; but this past 1.5 yrs i have not worked for pay, as i have nursed my stepdad, gram, and mom thru their final days ... dad and gram were on hospice care, and mom should have been. We were having the admission appt. on the day she died.

    I was often so frustrated with their docs NOT listening to me that i was in tears. I KNOW they are busy ... but it seems they have lost sight of the reason they are there.

    i personally LOVE miralax for recalcitrant drug-induced constipation ... have you had an opportunity to try this? Titrating this has worked well for many of my patients.

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