Blog / Random thoughts and musings.

The "C" word

No, not Cancer… the other “C” word — Constipation (and one other “C” word you’ll find out about it you are brave enough to make it to the end of this post). The past week has been one of the worst ever, for a condition I’ve never really thought much about. If you don’t want to read about my bowel activities, I won’t blame you for stopping here! I promise the next blog entry will be a bit more mundane.

Going into all this, I’ve known that severe constipation is one of the chief complaints of chemo patients. However, since chronic diarrhea is the main symptom of Crohn’s, constipation has never been something I’ve needed to think about, so I didn’t take the warnings too seriously. The constipation did catch up with me though, and with a vengeance.

By Monday I started feeling slightly nauseous throughout the afternoon, but assumed it was nausea due to the chemo. I had a lot of trouble sleeping that night.

Tuesday was much worse, with me spending most of the day on the couch doing nothing. The nausea got worse, especially after eating (which I did very little of), I had a constant pounding headache, and I felt weak and tired. Anti-nausea drugs didn’t seem to help at all. The headache and nausea prevented me from being able to do anything… even watching TV was a chore. I got almost no sleep Tuesday night, and wasn’t quite sure what was wrong.

Wednesday brought more of the same, until I vomited in my oncologist’s office during my mid-cycle check-up. I realized by now that I was constipated, but was not sure yet what that meant in relation to my other symptoms. I took laxatives Wednesday morning and evening, but despite the promises of “generally produces a bowel movement in 8 hours”, my bowels had apparently completely stopped, which was why I had started vomiting any time I ate. My doctor gave me a new anti-nausea drug, which I vomited in the car on the way home. Dinner didn’t stay down either (nor would anything from now on). I took an over-the-counter sleep aid but still didn’t sleep Wednesday night.

Thursday was just as bad, and I was feeling slightly like I was going crazy, having not slept in days, and spending all day with the pounding headache and nausea, doing nothing (no computer, no video games, no TV), and vomiting any time I ate. Not surprisingly, abdominal discomfort had also been increasing for the last couple days. I called the nurse at the oncologist’s office to get some advice. She said the “last resort” recommendation is a Fleets enema, so Kathie came home from work at noon and stopped at the supermarket on the way. Long story short, my excitement at reading “generally produces a bowel movement in 2-5 minutes” rapidly evaporated when nothing happened after 5, 10, 30 minutes. The day ended with no success, so the nurse made an appointment for me at 10am the next day. My doctor gave me a prescription sleeping aid (Restoril) but I only was able to sleep 3-4 hours Thursday night.

I had taken the recommended Sennecot-S laxatives Thursday morning and evening too, but Friday morning was much the same, with just a bit more sanity slipping away. After being examined by the nurse, I got sent for a quick x-ray to make sure I didn’t have a bowel obstruction, which I didn’t. The nurse said the biggest danger was dehydration, since I hadn’t been able to keep much of anything down for several days. She said one of two things were going to happen – either she was going to help me manage to keep liquids down, or she was going to put me in the hospital on IV fluids overnight. So, she gave me a mix of two anti-nausea drugs (Ativan and Decadron), had me wait 15 minutes for them to kick in a bit, and then had me start sipping a big cup of hot tea.

Well… the tea sipping went well, until all of a sudden, a half hour later, I realized my headache felt much better. After an hour, I’d had at least 20 ounces of tea, my headache was completely gone, my nausea was mostly gone, and overall I felt much, much better. That was when it dawned on me — this was the first caffeine I’d had in a week (and there’s that other “C” word). I rarely go a day without a couple cans of Coke. I’ve stopped for a week at a time several times in the past without any issues, but obviously that was without the added complication of chemo, so I mentioned it to the nurse. She agreed that stopping the caffeine suddenly, at the same time as starting chemo (and taking anti-nausea drugs, which can cause constipation), could have contributed to making my constipation so severe, plus causing my headaches and other symptoms. I was able to keep the tea down, so she sent me home with instructions to keep hydrated, caffeinated, and gave me a prescription for Ambien to help me sleep. Even though I was still constipated Friday evening, I mentally felt much better since the headache was gone. The Ambien helped me sleep a little longer than usual, but still only about 5 hours total. Then again, I did have at least 32 ounces of tea that day.

Maybe it was the kick-start of caffeine, or enough time, or enough laxatives, but Saturday morning things started to return to normal! I suspect the caffeine was the biggest contributor to solving the issue. I continued to feel better and better throughout the day, with no nausea, no headache, and no constipation… just still tired and a bit weak from not eating for a few days. I was able to eat breakfast, lunch, and dinner, and slept 7 hours straight Saturday night, so today I’m finally feeling up to doing things again (like updating this blog).

So, with my second round of chemo this coming Wednesday, I plan to keep my caffeine intake consistent (though not excessive), and start taking Senekot-S consistently. Hopefully round two will be much less eventful than round one! Tomorrow is my rescheduled outpatient surgery to get my chemo infusion port installed now that my blood counts are back up, so the actual chemo should go more smoothly as well. I also am hoping I can prevent the sore mouth from recurring by starting earlier on the salt water rinses. Several lessons learned, and hopefully I can put the results to good use! Time will tell…