Ileus

[Guest guest]

Carol....

Yes, it has everything to do with taking in any liquid or solid before the bowel resumes its work after abdominal surgery. I did not have an ileus, because I did not drink or eat anything for the first 5 days. I don’t know why this is such a mystery to the folks at UCSF. I half suspect that they don’t care all that much, because they know the patient will recover from the ileus, and the early nutrition can reduce ones chances of postop complications.

--

On 12/19/06 8:18 PM, " Carol " <dcvaughan@...> wrote:

I was wondering all day exactly what an " ileus " is. I had read some

link from and the one from , and it did help. But, now I'm

kinda worried about MY surgery....is this something that always happens

every time you have an abdominal incision? Or is there some particular

thing that sets it off? Are you supposed to take things by mouth quite

soon after surgery, or does that cause the ileus to be worse, or what?

I'm kind of confused...does it have anything at all to do with taking

liquids or soft foods by mouth? Is there anything that can prevent it?

R., or anyone who might have some answers....I'd appreciate it.

Carol V.

[Guest guest]

Dear Carol,

I was warned of Ileus by my doc before surgery. Kumar does stuff differently than some listed here, he keeps his patients out for the first day post op ( mind you he does revision as a one day process). So I wasn't awake till day two or three post op. I wonder if there is much more chance of ileus because others are back in there room quickly after a staged surgery and they aren't making sure there are bowel noise before allowing them to have nutrition. Even once I was awake Kumar had to give the go ahead for nutrition and he had to see me first before that could happen. I don't know if this is because he had a patient go through ileus, or what, but he did tell me of it before surgery.

I think following behind you are forewarned of this, and it definately something you should have a big conversation about with Dr. Hu.

While I didn't have ileus, I did have vomitting from med's ( fentanyl patch) and did get very constipated from it too. My best advice is to talk very frankly to your doc about all side effects from med's and not think that it will resolve itself. It's a blessing for those of you that follow behind some of us to know just what happens in the hospital, so you are forewarned, knowledge is good. But it also can be scary, and not all of us have the same reactions to any one thing. So while it's good to be informed, don't expect everything you here about here to happen to you. Good to be aware, ask questions of your doc. I had a decompression and 2 revisions in 24 months time frame, and only had some trouble following my last revision with vomiting, the other two surgeries were a very normal recovery and hospital stay. I now know that while the Fentanyl patch gave me excellent pain control, it gave my digestive system fits and I'll never use it again. So while is having a really hard time, it is possible to have a good recovery period at the hospital. I definately would have a discussion with Dr. Hu about ileus and how to avoid it. This is a tough surgery, and I'm so sorry she's having this complication, but from conversation yesterday it sounds like she maybe has turned the corner, and I'm sending healing thoughts from Colorado her way.

Colorado Springs

[ ] Ileus

I was wondering all day exactly what an "ileus" is. I had read some link from and the one from , and it did help. But, now I'm kinda worried about MY surgery....is this something that always happens every time you have an abdominal incision? Or is there some particular thing that sets it off? Are you supposed to take things by mouth quite soon after surgery, or does that cause the ileus to be worse, or what? I'm kind of confused...does it have anything at all to do with taking liquids or soft foods by mouth? Is there anything that can prevent it? R., or anyone who might have some answers....I'd appreciate it.Carol V.

[Guest guest]

Hi Carol,

I don't think ileus is a foregone conclusion. I had two surgeries a

week apart and did not have one. I was on a liquid diet (once gut

sounds returned) for 2 or 3 days each time....broth, jello, juice...

(and the Novatis product that was doctor approved which I brought to

the hospital).

Maybe is right, they know that eventually it will work

out...but I would prefer to be conservative...geez, you have enough

pain from the surgery...who needs puking and other complications!

For those of you on the board last winter you will remember that the

nurses were so conservative interpreting DrRands orders that Pa

had to threaten to order in a pizza for delivery if they didn't

start her on solids...as I recall it was day 4 or 5 postt op. She

didn't get an ileus...but she was hungry!

As says: Ask, Learn, Advocate for yourself!

Take Care,

Cam

[Guest guest]

Hi all,

This is the definition I found in wikipedia regarding Ileus.

I had anterior surgery with my revision and though I used stool softeners

for two weeks prior to

surgery, I had a time after I got home that was very uncomfortable while

getting my bowels straightened

out. My suffering was nothing compared to poor .

Mechanical ileus Main article:

Bowel

obstruction

Mechanical ileus refers to a lack of passage due to an obstruction, which

can be located anywhere in the bowel. The cause can be

volvulus or a

malignancy inside and outside the abdomen. Therapy consists of

surgery.

Paralytic ileus refers to a lack of passage due to paralysis of the

bowel, i.e.

Ogilvie

syndrome. This can be caused by intra-abdominal surgery, medication

(morphinomimetica), injury or infection.

Symptoms of ileus include, but are not limited to:

moderate, diffuse

abdominal discomfort

constipation

abdominal distension

nausea

/vomiting,

especially after meals

lack of bowel

movement and/or

flatulence

[Guest guest]

Hi Cam...

Just to clarify, an all liquid diet can still cause an ileus.

Regards,

On 12/20/06 5:43 AM, " cammaltby " <cammaltby@...> wrote:

Hi Carol,

I don't think ileus is a foregone conclusion. I had two surgeries a

week apart and did not have one. I was on a liquid diet (once gut

sounds returned) for 2 or 3 days each time....broth, jello, juice...

(and the Novatis product that was doctor approved which I brought to

the hospital).

Maybe is right, they know that eventually it will work

out...but I would prefer to be conservative...geez, you have enough

pain from the surgery...who needs puking and other complications!

For those of you on the board last winter you will remember that the

nurses were so conservative interpreting DrRands orders that Pa

had to threaten to order in a pizza for delivery if they didn't

start her on solids...as I recall it was day 4 or 5 postt op. She

didn't get an ileus...but she was hungry!

As says: Ask, Learn, Advocate for yourself!

Take Care,

Cam

[Guest guest]

Hi ...

I think the type of ileus caused by abdominal surgery is termed a paralytic ileus. Not sure if a mechanical ileus is the same thing.

Regards,

On 12/20/06 8:05 AM, " " <vclark@...> wrote:

Hi all,

This is the definition I found in wikipedia regarding Ileus.

I had anterior surgery with my revision and though I used stool softeners for two weeks prior to

surgery, I had a time after I got home that was very uncomfortable while getting my bowels straightened

out. My suffering was nothing compared to poor .

Mechanical ileus Main article: Bowel obstruction <http://en.wikipedia.org/wiki//wiki/Bowel_obstruction>

Mechanical ileus refers to a lack of passage due to an obstruction, which can be located anywhere in the bowel. The cause can be volvulus <http://en.wikipedia.org/wiki//wiki/Volvulus> or a malignancy inside and outside the abdomen. Therapy consists of surgery.

Paralytic ileus refers to a lack of passage due to paralysis of the bowel, i.e. Ogilvie syndrome <http://en.wikipedia.org/wiki//wiki/Ogilvie_syndrome> . This can be caused by intra-abdominal surgery, medication (morphinomimetica), injury or infection.

Symptoms of ileus include, but are not limited to:

moderate, diffuse abdominal discomfort <http://en.wikipedia.org/wiki//wiki/Abdominal_discomfort>

constipation <http://en.wikipedia.org/wiki//wiki/Constipation>

abdominal distension <http://en.wikipedia.org/wiki//wiki/Abdominal_distension>

nausea <http://en.wikipedia.org/wiki//wiki/Nausea> /vomiting <http://en.wikipedia.org/wiki//wiki/Vomiting> , especially after meals

lack of bowel movement <http://en.wikipedia.org/wiki//wiki/Bowel_movement> and/or flatulence <http://en.wikipedia.org/wiki//wiki/Flatulence>

[Guest guest]

How right you are - paralytic and mechanical ileus are two

different things. Mechanical ileus usually requires surgery, while

paralytic ileus resolves itself.

>

> > Hi all,

> > This is the definition I found in wikipedia regarding Ileus.

> > I had anterior surgery with my revision and though I used stool

softeners for

> > two weeks prior to

> > surgery, I had a time after I got home that was very

uncomfortable while

> > getting my bowels straightened

> > out. My suffering was nothing compared to poor .

> >

> > Mechanical ileus Main article: Bowel obstruction

> > <http://en.wikipedia.org/wiki//wiki/Bowel_obstruction>

> > Mechanical ileus refers to a lack of passage due to an

obstruction, which can

> > be located anywhere in the bowel. The cause can be volvulus

> > <http://en.wikipedia.org/wiki//wiki/Volvulus> or a malignancy

inside and

> > outside the abdomen. Therapy consists of surgery.

> >

> > Paralytic ileus refers to a lack of passage due to paralysis of

the bowel,

> > i.e. Ogilvie syndrome

<http://en.wikipedia.org/wiki//wiki/Ogilvie_syndrome> .

> > This can be caused by intra-abdominal surgery, medication

(morphinomimetica),

> > injury or infection.

> >

> >

> > Symptoms of ileus include, but are not limited to:

> > moderate, diffuse abdominal discomfort

> > <http://en.wikipedia.org/wiki//wiki/Abdominal_discomfort>

> > constipation <http://en.wikipedia.org/wiki//wiki/Constipation>

> > abdominal distension

<http://en.wikipedia.org/wiki//wiki/Abdominal_distension>

> > nausea <http://en.wikipedia.org/wiki//wiki/Nausea> /vomiting

> > <http://en.wikipedia.org/wiki//wiki/Vomiting> , especially after

meals

> > lack of bowel movement

<http://en.wikipedia.org/wiki//wiki/Bowel_movement>

> > and/or flatulence <http://en.wikipedia.org/wiki//wiki/Flatulence>

>

[Guest guest]

So, you're saying that they (UCSF) start pushing food and drink even

though they haven't checked to see if your intestines are working?

Should I (if I'm lucid enough) tell them to put me on very strong

nutrition via IV and wait for my insides to start working? Do they

just listen with a stethoscope to your intestines? Does everyone's

take different amounts of time to start working again? Five days

sounds like an awful long time to wait!!!

Carol V.

>

> > I was wondering all day exactly what an " ileus " is. I had read

some

> > link from and the one from , and it did help. But, now

I'm

> > kinda worried about MY surgery....is this something that always

happens

> > every time you have an abdominal incision? Or is there some

particular

> > thing that sets it off? Are you supposed to take things by mouth

quite

> > soon after surgery, or does that cause the ileus to be worse, or

what?

> > I'm kind of confused...does it have anything at all to do with

taking

> > liquids or soft foods by mouth? Is there anything that can

prevent it?

> >

> > R., or anyone who might have some answers....I'd appreciate

it.

> >

> > Carol V.

>

[Guest guest]

Hi Carol...

I did not have my scoliosis surgery at UC, so I can’t answer your questions.

According to this really good, detailed article:

http://www.emedicine.com/med/topic1154.htm

“The small bowel typically regains function within hours. The stomach regains activity in 1-2 days, and the colon regains activity in 3-5 days (Cameron, 2001). Serial abdominal radiographs mapping the distribution of radiopaque markers have shown that the colonic gradient for resolution of postoperative ileus is proximal to distal. The return of propulsive activity to the right colon occurs earlier than to the transverse or left colon (Tollesson, 1992). “

One thing you need to understand if you’re having your surgery done UCSF, or at any large hospital, especially if it’s a university hospital. The people in charge of your post-op care are usually fellows and residents, and not your surgeon. I’m guessing that your experience depends a lot on who you get. And, since these doctors have probably chosen orthopaedics as their area of specialty, they know fairly little about gastrointestinal issues.

I can tell you that if I were going in for anterior abdominal surgery, I would make it very clear that I do not want any nutrition by mouth until they’re certain it’s completely safe. I have also intentionally chosen a primary care physician with privileges at UCSF so that I can put him in charge if/when I decide to have more surgery. I don’t know if that’s a viable option for others.

Regards,

On 12/20/06 7:27 PM, " Carol " <dcvaughan@...> wrote:

So, you're saying that they (UCSF) start pushing food and drink even

though they haven't checked to see if your intestines are working?

Should I (if I'm lucid enough) tell them to put me on very strong

nutrition via IV and wait for my insides to start working? Do they

just listen with a stethoscope to your intestines? Does everyone's

take different amounts of time to start working again? Five days

sounds like an awful long time to wait!!!

Carol V.

[Guest guest]

,

Yes, I know that ileus is the result of a return to any diet before

motility returns to the gut. I lived on ice chips for 2 or 3 days

until it seemed that things were " happening " , then a very close

watch on bowels with all the bells and whistles, followed by another

two or three days of just liquids.

It may be random luck, (and not a scientific survey!) but it seems

to me you west coasters have had a higher incidence of ileus...and

also seem to be eating heavier and sooner, from what I have read

here. (I think you reported that was eating cheesburgers not

long after surgery...yikes). If an ileus should develop, isn't a

patient still going to be better off, when activity resumes, if you

are not all packed up with whatever has stopped moving through? My

brother developed an blockage after broken ribs from a fall from a

ladder/narcotics/immobility laid him low. His body finally decided

the only way to rid itself of what was not going down was to throw

it up....I really can't imagine doing that following spine

surgery...and I am very sorry that or anyone has had to

undergo that.

As with anything...you have to follow your doctors orders...but it

is a fair question to talk over with the doctor/and even when you

are laying in bed desparately wishing for some real food, it is good

to understand why the nursing staff is still just bringing ice chips

to chew on!

Take Care, Cam

>

> > Hi Carol,

> >

> > I don't think ileus is a foregone conclusion. I had two

surgeries a

> > week apart and did not have one. I was on a liquid diet (once gut

> > sounds returned) for 2 or 3 days each time....broth, jello,

juice...

> > (and the Novatis product that was doctor approved which I

brought to

> > the hospital).

> >

> > Maybe is right, they know that eventually it will work

> > out...but I would prefer to be conservative...geez, you have

enough

> > pain from the surgery...who needs puking and other complications!

> >

> > For those of you on the board last winter you will remember that

the

> > nurses were so conservative interpreting DrRands orders that

Pa

> > had to threaten to order in a pizza for delivery if they didn't

> > start her on solids...as I recall it was day 4 or 5 postt op. She

> > didn't get an ileus...but she was hungry!

> >

> > As says: Ask, Learn, Advocate for yourself!

> >

> > Take Care,

> >

> > Cam

> >

>

[Guest guest]

,

Paralytic ileus was defined in the passage I quoted as:

Paralytic ileus refers to a lack of passage due to paralysis of the

bowel,

i.e. Ogilvie syndrome This can be caused by intra-abdominal surgery, medication

(morphinomimetica),

injury or infection.

[Guest guest]

I was apparently really lucky. My revision ended up being 3 stages, Aug. 25, Sept. 8, and Sept. 27 (not the lucky part!), and of the 3 surgeries, the third, A/P surgery was the one from which I regained bowel motility the fastest. Even so, they didn't move me up from ice chips to water until I'd told them several times that I was passing wind. Then came clear liquids, followed by "full liquids" which included things like ice cream, Boost, even Cream of Wheat cereal. It does seem like they moved me up to full liquids a bit fast, but I felt like it was ready to move, and it did. They didn't start me off on meatloaf or even a veggie burger! Full meals came only after some good bowel movements.

Anyway, I was lucky and got eating and moving fast. Pushing me to full liquids ahead of schedule could have been a problem but wasn't. This was New England Baptist, and I think their protocol is pretty good.

Sharon

[ ] Re: Ileus

,Yes, I know that ileus is the result of a return to any diet before motility returns to the gut. I lived on ice chips for 2 or 3 days until it seemed that things were "happening", then a very close watch on bowels with all the bells and whistles, followed by another two or three days of just liquids.It may be random luck, (and not a scientific survey!) but it seems to me you west coasters have had a higher incidence of ileus...and also seem to be eating heavier and sooner, from what I have read here. (I think you reported that was eating cheesburgers not long after surgery...yikes). If an ileus should develop, isn't a patient still going to be better off, when activity resumes, if you are not all packed up with whatever has stopped moving through? My brother developed an blockage after broken ribs from a fall from a ladder/narcotics/immobility laid him low. His body finally decided the only way to rid itself of what was not going down was to throw it up....I really can't imagine doing that following spine surgery...and I am very sorry that or anyone has had to undergo that.As with anything...you have to follow your doctors orders...but it is a fair question to talk over with the doctor/and even when you are laying in bed desparately wishing for some real food, it is good to understand why the nursing staff is still just bringing ice chips to chew on!Take Care, Cam> > > Hi Carol,> > > > I don't think ileus is a foregone conclusion. I had two surgeries a> > week apart and did not have one. I was on a liquid diet (once gut> > sounds returned) for 2 or 3 days each time....broth, jello, juice...> > (and the Novatis product that was doctor approved which I brought to> > the hospital).> > > > Maybe is right, they know that eventually it will work> > out...but I would prefer to be conservative...geez, you have enough> > pain from the surgery...who needs puking and other complications!> > > > For those of you on the board last winter you will remember that the> > nurses were so conservative interpreting DrRands orders that Pa> > had to threaten to order in a pizza for delivery if they didn't> > start her on solids...as I recall it was day 4 or 5 postt op. She> > didn't get an ileus...but she was hungry!> > > > As says: Ask, Learn, Advocate for yourself!> > > > Take Care, > > > > Cam> >>