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    #16
    PEG to Enemeez- thst is what they I heard they were going to add late last year. And he got no results? That is concerning. Too large, too hard/dry?CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #17
      Originally posted by SCI-Nurse View Post
      PEG to Enemeez- thst is what they I heard they were going to add late last year. And he got no results? That is concerning. Too large, too hard/dry?CWO

      Today we tried a Dulcolax, and then an old version Enemeez (no PEG added yet - because that was the only version I had at home and the hospital didn't have any) and an enema. Nothing yet. He is not backed up per se. He just doesn't respond to stimulation from below well at all. Never did. Plus all of the medical issues/no oral bowel meds/not vertical on toilet/on a fentanyl drip and who knows what...

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        #18
        Originally posted by paraparajumper View Post
        I am so sorry your dad is in that situation. What is the reasoning for being NPO still? They cannot put meds down that NG tube at this point?

        I'm guessing he would be NPO if they were considering taking him to surgery to address an obstruction since at some point the bowel would die off and would need to be resected. Imaging would drive that surgery recommendation I would think. But if they're deeming obstruction is not the cause then why are they not getting more aggressive with enteral bowel meds?

        Or parenteral nutrition?

        I really wish this country had IryPump like I use. I had to really go out of my way to find a pharmacy in another country to buy them for me. Such a hassle but I bought 2 to make sure I have them well into the future. Colonic irrigation by powered pump is the best.

        Is he on large amounts of opioids? Maybe consider methylnaltrexone, it's given as an injection to treat opioid induced constipation by blocking peripheral opioid receptors.

        Great questions.

        He is still NPO because he is still putting out large amounts of fluid from the NGT. They are still actively decompressing him. There is an argument/disagreement among his doctors whether he has a partial obstruction, an ileus, or some of both. There are also some subtle signs on the CT scan of ischemia at the level of the partial obstruction, and the doctors disagree on the significance of that too. If ischemia + possible obstruction, they don't want to risk using promotility agents in case they cause a rupture.

        He is on a fentanyl drip, and on opioids at baseline for chronic neuropathic pain. They are nixing the specific opioid antagonists too, presumably because they consider that similar to a promotility agent.

        Colonic irrigation sounds amazing. Actually, I am going to suggest it tomorrow to GI, if they come by. I'm sure they will say no, because now he is on Heparin with low-ish platelets for new Atrial fibrillation, which started yesterday.

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          #19
          His previous wound care physician told me to request a Group 3 bed - Dolphin or Clinitron bed. And ask about TPN. Thoughts?

          It is so difficult to ask for things in a hospital when you are the patient's family.

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            #20
            dolphin most likely possible. Is he on Fentanyl? GE doctor needs to recommend med for OIC,( opioid induced constipation ) but he is being sedated for vent so have to consider that. We have been using some for SCI NGB. How many mls. in enema? Try at least 1000mls. Enema. At TIRR we did a SMOG enema. CWO
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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              #21
              Originally posted by SCI-Nurse View Post
              dolphin most likely possible. Is he on Fentanyl? GE doctor needs to recommend med for OIC,( opioid induced constipation ) but he is being sedated for vent so have to consider that. We have been using some for SCI NGB. How many mls. in enema? Try at least 1000mls. Enema. At TIRR we did a SMOG enema. CWO
              Thanks for your thoughts. I really pushed today and they are getting him a Dolphin mattress. I think they are worried about his sore, and they saw me taking pictures of it...

              Great idea about the OIC med. We talked about starting that, but weaned the fentanyl instead. And then we had a breakthrough today. After failing with a dulcolax supp. and a new enemeez, we started the prokinetic medicine erythromycin and he moved his bowels.

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                #22
                Great news! They all probably brought it down some, but needed more to get it out. Erythromycin is an antibiotic also. Hope this will help his other issues. CWO
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                  #23
                  Originally posted by hlh View Post
                  Great idea about the OIC med. We talked about starting that, but weaned the fentanyl instead. And then we had a breakthrough today. After failing with a dulcolax supp. and a new enemeez, we started the prokinetic medicine erythromycin and he moved his bowels.
                  That was my recommendation: methylnaltrexone for OIC. Given by injection, so at least bypassing the GI. Even if he's on higher levels of opioids during this hospital stay, if he still takes a baseline level of opiates, I feel like having that on board would provide some benefit since he is a lot more sedate than usual. Unless it's contraindicated for some reason.

                  Any updates regarding the obstruction? So what exactly is their gameplan, repeat imaging in a bit? Obstruction + sepsis is a bit worrisome for rupture and translocation of bacteria, but you'd usually see a little bit more on imaging outside the bowel if that was the case. If the hiatal hernia was the cause imaging would see his bowel through that hernia. I guess unless it was strangulated then moved back. Do you have the imaging report?

                  I am quite partial to Clinitrol beds since I've had success with them on multiple long-term flap surgeries, but SCI-Nurse knows way more than I do regarding beds.

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                    #24
                    The Dolphin mattress is amazing. I am so glad we got it. But his new sore looks terrible. The Dolphin mattress is too late, I'm afraid. We'll have to see how it evolves.

                    Everyone is pleased about his bowels. We're definitely still considering the anti-opiate medication, if needed.

                    But he is still very sick, so weak, and just at the borderline of being able to tolerate weaning off the "pressor" medications. Recovering from the septic shock is the biggest problem and is slow and steady. Decisions are still one day at time, which is stressful. I wish he was able to express his preferences better.
                    ​​​​
                    ​​​​​Being in a small hospital where the doctors are not supportive is awful.


                    Yes, they repeated a CT yesterday, and his potential blockage looks much better and the potential signs of ischemia are gone (air in the wall). Definitely no rupture. The working diagnosis is more of a chronic translocation of bacteria with intermittent partial obstruction. There also is debate as to how much the para esophageal hernia is contributing, as there is bowel herniated in his chest too. But there are two potential surgical areas that might need to be explored long term (blockage site - adhesions or ? And the para esophageal hernia causing chronic reflux/pneumonias). When you are just trying to survive an ICU stay, the idea of surgeries or pressures sore on top of it is awful.

                    ​​

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                      #25
                      He has passed a hurdle but he has many more. He is lucky to have you for an advocate. He needs bowel program daily, minimally. CWO
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                        #26
                        Originally posted by SCI-Nurse View Post
                        He has passed a hurdle but he has many more. He is lucky to have you for an advocate. He needs bowel program daily, minimally. CWO
                        Thanks. It is a constant battle.

                        They stopped all of his new bowel medicines over the weekend! I only discovered it today, as I wondered why no BM yesterday, and I am so upset. At least he got an Enemeez, but it doesn't do anything on its own. Why did this happen? Who knows..... Everyone was happy he went on Friday, and then no one continued the medications the next day? The ICU attendings changed over Saturday morning, terrible communication between the two and no continuity of care (no MD in the ICU at all except for a few hours each AM). And terrible communication with GI. And of course, everyone irritated by me, pushing for my father.

                        At least the erythromycin should be restarted tonight.

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                          #27
                          It sounds as though you are being a great advocate for your Dad. Medical people sometimes need a push to do something. Especially if they are uncertain in a situation. I am betting that many of them don’t have much experience with individuals who have a SCI.

                          Hang in there and please continue to use this site for questions and support.

                          ckf
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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