Another obstruction didn’t sign up for this!

I would go. I know hospitals are no fun, especially after multiple surgeries and issues. But push for answers and to get the help you need.

Partial obstructions can be very difficult to see with imaging studies. Obviously it was real.

For the current problem, are you able to drink water? Are you well-hydrated, with light-colored urine? Are you able to hold down liquids with some nutrition, like grape juice? Are you vomiting? Are you still producing stool and/or gas?

A partial obstruction will usually clear on its own, but it’s important to stay hydrated, even if it takes an IV. A complete obstruction is a big deal.

Bubba, you sure have a lot on your plate! You are in good company as I know of no one who enjoys trips to the doctor, and especially the ER. Scott summed things up pretty well.

You have experience with this. If you can keep fluids down and have stopped all solids, it seems OK to wait and see if things sort themselves out or progresses to a serious obstruction. Tylenol isn’t going to do anything for this sort of pain. You are better off with a heating pad on your belly and self massage.

You will know if things get to the point getting yourself to the ER. But, the choice is yours. Only you know what your tolerances are.

Jan

I am sorry about your suffering dear.

Whenever I had obstructions with my ostomy, I always went in no matter what. The doctor said I always did the right thing by coming in. I think its better to be safe than sorry. I always like to plan for the worse, that way I am always prepared and ahead.

A few tips for the future for possible prevention:  Drinking water before, during, and after every meal. And moving around after eating. Those tips help me always. A lot of people say those tips work for them as well. I hope this helps for the future.  

Would definitely recommend going to the hospital. Hope everything is okay, keep us updated

I just came home from a partial obstruction with my loop ileostomy and I never stopped having output

It was painful

I hope you get better soon

Thanks for your replies. A partial obstruction can still give you output I believe. Either way it is painful, no doubt about it.

This entire weekend I’ve had pain on and off which is really weird- makes me think it’s just gas. Today it’s bad enough (this morning and I obviously haven’t eaten anything all night) where I can’t really stand up straight. I called my surgeon to see what she suggests. It’s not going to hurt to tell her what’s going on- she said to call! I mean I don’t have any other organs down there besides lady parts and those won’t cause this pain! It’s not kidney stones - I’ve had those and this isn’t that pain!

I’ve been pushing the liquids like you all have suggested but I’ll see what she says. I did get hungry but did keep it to soft foods like plain pasta and bananas etc. Fingers crossed we figured it out. Maybe adhesions?

@Bubba1028 posted:

Thanks for your replies. A partial obstruction can still give you output I believe. Either way it is painful, no doubt about it.

This entire weekend I’ve had pain on and off which is really weird- makes me think it’s just gas. Today it’s bad enough (this morning and I obviously haven’t eaten anything all night) where I can’t really stand up straight. I called my surgeon to see what she suggests. It’s not going to hurt to tell her what’s going on- she said to call! I mean I don’t have any other organs down there besides lady parts and those won’t cause this pain! It’s not kidney stones - I’ve had those and this isn’t that pain!

I’ve been pushing the liquids like you all have suggested but I’ll see what she says. I did get hungry but did keep it to soft foods like plain pasta and bananas etc. Fingers crossed we figured it out. Maybe adhesions?

Your welcome, hope you feel better.

No obstruction. Nurse just called to tell me results but said doc will call me in the AM to discuss once she reviews. So why does it feel like someone punched me in the stomach? I mean something must be going on.

CT scan showed kidney stones but they weren’t big enough to obstruct. And that’s not where my pain is- it’s not in the side/back. My pain is stomach/abdomen. I’m at a loss.

Kidney stones mean you really need to raise your game on hydrating, although the obstructions or partial obstructions may be interfering with proper hydration, creating a Catch-22 situation. Going forward you are going to need to hydrate intensely. Those stones form from highly concentrated urine.

yea I’ve had them before- had to have a stent put in (two months after having a c section- that was fun)! Said we’re prone to them because we are tend to be dehydrated. Suppose I should I call my urologist.  

Back in 1992 when I got my J Pouch  I was told by my surgeon that we are prone to kidney stones, and to maintain a proper level of hydration. However I never had any kidney stones in 29 years with a J pouch. I think there are genetic factors that predispose one as well. But the bottom line is they are prevented and combatted with excellent hydration hygiene.

Yes you are correct. I believe people who have familY members who have them are also more likely to have them. I saw my doc today and I have a total of 11 kidney stones! Ugh! Need to drink more! Hopefully they pass on their own.

Hi Bubba. Am I correct in thinking it is the kidney stones that have been causing your pain? And have things improved with increased hydration?

Also, I'm very curious about the lupus syndrome  you experienced following Humera and specifically how it has affected you (or is it effected? I can never remember the difference!). I felt like I was the only one on this forum who has experienced it. Humira seems to be a gods send for most people.

Thanks.

@Bubba1028 posted:

Yes you are correct. I believe people who have familY members who have them are also more likely to have them. I saw my doc today and I have a total of 11 kidney stones! Ugh! Need to drink more! Hopefully they pass on their own.

I would suggest in telling your doctor to putting you on Pottassium Citrate ASAP! Potassium Citrate helps to decrease kidney stones and even stop them from forming. I suggested it to someone on this forum before But I do not remember who it was, I believed it worked for her. My dad takes Pottasium Citrate 4x a day dosage of 1080mg and he has not had a kidney stone since. I would definitely suggest that medicine

Humm he didn’t mention the potassium citrate at all bit he did mention for me to swap my calcium carbonate that Intake for my bones (thanks to the years of prednisone) to calcium citrate so maybe that’s similar. He said it helps flush stuff out with the benefits of keeping the calcium. I’ll ask the next time I’m there. They’ll be doing another ultra sound in a month or two to see if they’ve grown/ passed. Im hoping that’s what the pain was from but the doc wasn’t sure. He says the stones were still in my kidneys so he just said “ they will be uncomfortable when they pass” but didn’t say if I’m actively passing them. Kind of obscure. I think I was so shocked as he counted up how many I had I didn’t know what to ask! I had a stent put in for some stones a few years back so at least he said we were there yet. These are able to be passed at this point.

jhendrix- as for the lupus- I don’t have any symptoms at all. The only reason I had to go off it was bc my blood work indicated I had high ANA, Histone levels, and a few other things. And my rheumatologist checked my blood work several diff times to be sure bc she didn’t want to take me off it. It’s drug induced meaning as soon as I go off it, my levels should go back to normal. I can go back on another drug like Stelera. I have tried Cimzia and Entivio and both failed- Cimzia worked well for a while though. Keep on trucking I guess. But other than that I feel good..

Heads up. Please do not take potassium supplements unless instructed to do so by your doctor. High levels can be lethal. What works for one person can kill another. -- Rose

Good catch roseviolet! Supplemental potassium should be by doctor’s recommendation and with lab monitoring. Generally, doctors do not like to be told what to order. But, it is perfectly fine to discuss whether a supplement is needed.

Jan

Kidney stones can be made of different materials, depending on what’s going on in the body. There’s even more than one kind of calcium stone. The proper treatment depends on the kind of stone, the wrong treatment can make it worse, and it’s best to ignore glib, uninformed treatment instructions. In particular it’s tricky when you’re trying to get more calcium into your bones but less calcium into your urine, and this balancing act benefits from thoughtful medical attention. The general recommendation to stay properly hydrated at all times seem to be reliable for most of us, though.

yes they did test the stone to see what type I had. Doc said to add citrus drinks like OJ and  cranberry which will help with my type of stone.

I also did a 24 hour urine catch to see how much urine I outputted. I outputted 400 CCs the average person outputs 2000 CCs. So I need to drastically increase. Ugh.

He said “well, if you drink more, I know you’ll go have more stool, and who wants to go like 8x a day, but it’s worth it in the long run.” And here I’m thinking, 8x a day? I’d be lucky if I did that! I go 12-15x! I know it’s not his area but he’s got no idea. Lol

I do drink half Gatorade (the sugar free)/half water in the morning bc I’m super thirsty waking up. That has potassium in it so that’ll help!

Drinking more water will not necessarily result in more BMs. I tend toward the constipated side of things with my small intestine doing an excellent job of resorbing fluids. Too good, in fact, making it difficult to pass formed stool. I can drink a gallon of water and all I do is pee more, which is normal physiology and what you want. I suspect motility has a lot to do with it, with mine being on the slower end. Most seem to accomplish slowing there’s with Imodium or Lamotil. I quicken mine with prune juice. Anything you can do to slow transit time and allow more time for your gut to absorb fluid is a good thing—more peeing less pooping.

@Scott F posted:

it’s best to ignore glib, uninformed treatment instructions.

Agree- Stick with the advice of your medical doctors.

Bubba- regarding hydration- I also drink Gatorade Zero and it has safe amounts of potassium and electrolytes. As mentioned by the prior posters, very low and very high potassium levels can cause a potentially life threatening situation (it can lead to cardiac arrest). My recollection is that there was a rash of such deaths at Mount Sinai Hospital in NYC in the early 1990s which was caused by infusing potassium to patients who were very low in potassium after colectomy and other surgical procedures disrupting electrolytes. The human body cannot handle rapid absorption of large quantities of concentrated potassium. This caused a change in hospital procedure, and those who had life threatening low levels of potassium after surgery, of which I was one, were required to imbibe it rather than get infused with it. To slow down the absorption and also limit the quantity. That's the very highly concentrated stuff though, which is blood red in color and has the most vile taste you can imagine. Gatorade Zero, on the other hand, is harmless and probably also doesn't have enough potassium in it to meaningfully treat kidney stones or do anything other than help maintain a proper electrolyte balance. Which of course is itself a way to prevent recurring kidney stones.

Potassium is still frequently infused but the rate does need to be limited to 10-20 mEq/h. You can get away with faster rates for severe hypokalemia in patients who have a central line. K through a peripheral line, as many of us have experienced, can really burn and blows IVs, necessitating the rate to be slowed. They often replete using both IV and PO K and as CT mentioned with close monitoring (daily K levels). In super sick ICU pts, hourly K levels.  I agree, don't take K unless prescribed with monitoring.

Bubba, I meant to respond earlier in your course but didn't get a chance. I have had a ton of obstructions, one with my end ileo then several with my loop ileo. Hospitalized twice for them, the rest I stayed at home. I always struggle like you with when to go in or not and my threshold for going to the ER, after observing how each obstruction behaved and resolved, is intolerable pain and vomiting. Both times I went in, I just couldn't handle the pain any longer (even with burning through left over opioids at home) and then shortly after started projectile vomiting. The way I see it, the danger of not going in is developing bowel necrosis requiring surgery. My last obstruction, I had fat stranding around my severely distended bowel and an elevated lactate so flirting with a surgical issue. The pain and vomiting that time was impressive so I can now use that as a barometer of the danger zone. If my pain is "tolerable" and I'm not vomiting, I'm probably not in need of a surgical eval and all they will do is decompression, NPO and time. I ask myself, "self, is this so bad that you are willing to have an NGT?" Once the vomiting starts the answer is usually yes.

Oh, and I forgot to mention, you need to replete magnesium in order to replete potassium. So it gets more complicated than simply popping some OTC KCl.

@Pouch2021 posted:

Potassium is still frequently infused but the rate does need to be limited to 10-20 mEq/h. You can get away with faster rates for severe hypokalemia in patients who have a central line. K through a peripheral line, as many of us have experienced, can really burn and blows IVs, necessitating the rate to be slowed. They often replete using both IV and PO K and as CT mentioned with close monitoring (daily K levels). In super sick ICU pts, hourly K levels.  I agree, don't take K unless prescribed with monitoring.

Bubba, I meant to respond earlier in your course but didn't get a chance. I have had a ton of obstructions, one with my end ileo then several with my loop ileo. Hospitalized twice for them, the rest I stayed at home. I always struggle like you with when to go in or not and my threshold for going to the ER, after observing how each obstruction behaved and resolved, is intolerable pain and vomiting. Both times I went in, I just couldn't handle the pain any longer (even with burning through left over opioids at home) and then shortly after started projectile vomiting. The way I see it, the danger of not going in is developing bowel necrosis requiring surgery. My last obstruction, I had fat stranding around my severely distended bowel and an elevated lactate so flirting with a surgical issue. The pain and vomiting that time was impressive so I can now use that as a barometer of the danger zone. If my pain is "tolerable" and I'm not vomiting, I'm probably not in need of a surgical eval and all they will do is decompression, NPO and time. I ask myself, "self, is this so bad that you are willing to have an NGT?" Once the vomiting starts the answer is usually yes.

Definitely agree.  It's sometimes difficult to know when to go to the ER when you're dealing with partial obstructions. I've had several that have passed at home. I generally judge by pain and duration, but if I start having any nausea or vomiting I will go regardless, or of course if I have a fever. On the last occasion when I did go, I was in the ER for hours awaiting x-ray results, only to be told "things don't look too bad" and was discharged home to continue fluids and monitor for any worsening symptoms or fever.  That experience has essentially become my barometer as far as determining when I may need to go as well.

For what (if anything) it's worth, I've found that I had to go into the hospital with the loop obstructions but have not had to with pouch partial obstructions. I was fortunate in that I used to be able to go right to the ward and bipass the ER which made it much less daunting.