Completely Obstructed

Ladylacy said:

Your Mother

Sorry to hear about your mother.  My husband has had several dilations.  The last one was in February.  He is open enough to swallow, but relies on his feeding tube and I think this is because his esophagus has narrowed considerably.   The last dilation the doctor thought they would have to go up thru his feeding tube and down his throat, but thankfully they didn't have too.  Radiation scars quite bad.  I know his first round of radiation completely closed off his throat and they had to reconstruction his throat. 

Second round of radiation did close off his throat, but thankfully they were able to open it.  But now he is dealing with a recurrence of cancer at the cervical of his esophagus and spread to his right lung.  He has elected to do nothing else.  Only thing offered was chemo which wouldn't cure, only prolong and possibly hasten.  To date he is doing pretty good.  No signs but low energy level.  He takes lortab for pain and does quite well.  He was also a heavy beer drinker and smoked a pipe for over 40 years. 

You might ask the doctor about a stent.  Some people have no problems with a stent while others have lots of problems.  We did talk about a stent, but the specialist said that he wasn't for stents because the tumor could grow around the stent causing more problems.   Whatever, it is your mother's decision, as hard as it sounds.  I don't like my husband's decision and neither do our sons, but we aren't saying anything.  I would rather have him doing what he wants then suffering from chemo.  Ask the doctor about your mother's pain medication.  Everyone reacts differently to medication.  My husband is having no problems with his.

Best wishes -- Sharon 

Hi Amy ...

Several things here ...

 

1.  I have no experience with dialation and not being a doctor I could never predict the "chances" of success, however one thing I have learned on this forum is "odds" don't matter.  I whispered a prayer she can have the dialation and it will be a success.

 

2.  As for if the worst case scenario plays out and mom wants to die and "how can you help her" ..legally you can't.  Nobody can.  It hurts me to see anyone want to die bc that means they are in pain or depressed. If it's the pain speaking, of course talk to your team of docs and work on a pain management plan of attack.  If it's the depression speaking, gosh, some periods are worse than others, sometimes those dark periods pass ....but of course they have meds for that too.

 

I wish I could be more helpful.  You certainly have your hands full and I also whispered a prayer you and your family will find strength to continue to aid your mother in anyway you see fit.

 

Best,

Tim

amy, i've had my throat

amy, i've had my throat dilated several times.  i still have problems swallowing tho.  my pills always get stuck and my food sometimes gets stuck.  is your mom having trouble swallowing pills, food or both?  maybe the swelling will go down some before she gets the dilation again.  i'll keep my fingers crossed.  i'll be praying for you and your family.  i wish you the very best.

God bless,

debbiejeanne

Amy0309 said:

Thank you Deb

Thank you Deb.  My grandfather passed the same way at 97.  It was a bit of a long process for him as he was still very healthy just tired. 

Hi Amy

Your Mom and I have two things in common, dilations and hydrocodone.  Since June of 2007, I have been dilated almost 50 times.  As a matter of fact, I have one scheduled for April 30th.  If I had to bet about your mother's case, I would say the inability to dilate was due to swelling rather than scar tissue since it really hasn't been that long since her radiation.  My rad treatments were finished in May of 2004.  I didn't start having problems swallowing for three years.  At first, I used to be dilated every couple months, then it went to every 4 to 6 weeks, then to monthly.  These dilations were keeping me swallowing until I hit the BIG roadblock in 2011.  That is when I had the mandible surgery.  I've been on a feeding tube ever since.  We've tried dilating but it just won't stay open, then I had an epiphany.  I was trying to figure out what was different now as opposed to then.  I got my speech/swallow therapist to check the results of the swallow test I had in June of 2011 before I had the surgery.  At that time, my hyoid bone in the throat was monving forward to initiate the swallow.  In the test in December of 2011, it wasn't.  The only thing different was 6 more months of neck fibrosis had built up plus swelling from residual edema because of the surgery.  A couple weeks ago, I discussed this with my surgical ENT and he said it was very possible that this was the cause of the stricture not staying open.  I also came to this conclusion because at the end of last year, my other ENT had prescribed prednisone before I had sinus surgery.  On the 8th day of the treatment, I had my semi annual checkup with my rad onc.  He remarked about how my tongue was nowhere near as swollen as it usually is.  When I got home, I decided to try to swallow some water.  I tried four, separate small sips.  None of them came out of my nose or made me cough which means they went down my esophagus like they were supposed to.  So, in your Mom's case, the swelling may be keeping the esophagus so tightly closed that they are afraid to push any harder.  After this upcoming dilation, we are going to try prednisone again to see if that helps.  If it works, you will hear my squeals of delight all the way over on the west coast!

Now as far as the hydrocodone is concerned, did you hear her doctor say take as much as she wanted or is that what she told you?  In 24 hours, I usually take about 60mg.  I have 10mg tablets that are scored so I can break them in half.  Her tablets might only be 5mg or 7.5mg.  I've been taking it again now for several years.  Between my neck and throat discomfort, I usually take anywhere from 5 to 15mg every four hours.  In a couple rare instances, I've taken a 20mg dose.  Hydrocodone is not like aspirin or ibuprophin where you take it and 15 minutes later your headache is gone.  You need to build up a level in your system  to have any effect.  I think I'be rambled on enough.  I hopeI have given you a little insight into your Mom's problems.

Amy0309 said:

Hi George, thank you for the

Hi George, thank you for the informative response.  Great thinking on you part about the prednisone, I do have a bit of medical knowledge and I think you have a fantastic idea, look forward to hearing screams of delight on there way to the west coast, I am on the way in the Chicago area.  I agree that this could be early for such scar tissue to develop, but his reponse after surgery was not very positive, I asked if more time could decrease it.  He indicated possibly/slightly.  Also, the operative report indicates there is no lumen(opening) at all a complete obstruction and it describes the tissue as firm and sounds like it is a mangled mess.  Would swollen tissue be different then scarred?  You have me thinking of some good questions for the doctor.

She is really not taking that much medication and I think part of the problem was the general anesthesia as well, a couple of days later she was much better.  Her hydrocodein is 5mg and I think she can take it every 6 hours.  She is back to taking a half in the am and evening then a full one at night now.  She also is on Ativan in the am only, it helped her with withdrawl and I believe it helps her now for anxiety and she takes something mild for the depression(Miratzapine).  That is it. The past couple of days she has felt awful though, stomach ache and just so tired, she does a continuous feed most the night, we are slowing that down, possibly the rate is a bit high while her body is healing, there is no fever.  We will see what the next couple of days bring.  Thank you again, Amy

My dilations

used to be done by my gastroenterologist.  Earlier this year, I had a colonoscopy scheduled and I asked him to do the dilation at the same time.  When I woke up, I found out that he was afraid to do the dilation when he looked.  He wrote in his report that I might want to get used to the idea that I may never be able to swallow again.  Needless to say, that didn't sit to well with me.  I asked my surgical ENT if he would try to do the dilation.  He said sure.  He did the procedure and said he really thought he would meet with more resistance.  He had no problem getting the dilator in my throat but, as usual, the stricture didn't stay open.  I bring this up to point out that maybe a different doctor would see things differently.  Is your Mom's dilations being done by a gastroenterologist or an ENT?  After April 30th, when I find out whether to just give up hope, I hope to go back to the gastroenterologist who's been doing them on me since 2007 and getting him to start back dilating me again.  My ENT does his procedures in a regular operating room rather than an endoscopy suite.  I have to get a pre-op, bloodwork, and ekg every time my ENT does it.  It becomes a pain in the tail.

I'm not a doctor but I would think if there was alot of swelling, you wouldn't really see the lumen too well either.  As far as the hydrocodone goes, it doesn't sound like she is abusing the drug at those small doses.  My directions say I can take one or two tablets every four hours as needed for pain.  Keep in mind, mine are 10mg where hers are 5mg.  I usually take one tablet every four to six hours.  As I said before, sometimes it's only half a tab, sometimes it's a tab and a half.  Compared to her, I am a raging addict, LOL.