Guess I Was Wrong

wolfen
wolfen Member Posts: 1,324 Member
in Head and Neck Cancer #1

Silly me, I thought we might make it into April without another visit to ER.   WRONG!

Last night at midnight, hubby was sitting in the recliner just watching TV. All of a sudden, he called to me and his skivvies were soaked with blood. That damm G-tube was pouring blood from the incision site again. This time, at 12:15, no less, I called the surgeon's cell phone(he gave me the # and said to call if it happened again, but probably didn't expect a midnight call). He said to call 911, so I did and they carted him off to our local ER. I filled the doc in on the solution from our previous visit there, so he put in a few stitches and all is well again.

The surgeon called earlier to check on him, but I missed the call. So I'm waiting for him to call back. I don't want to bother the man on Easter Sunday in case he has family stuff going on. I feel like an idiot already for calling him last night, but he is the one who told me to do so.

This is too crazy. We really need to find out what is causing this. As far as I know, chemo is still on for tomorrow.

Luv,

Wolfen

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    #2
    Is he taking blood thinners?

    just a thought that perhaps blood thinners and a "PEG" don't mix very well.  There are other types of feeding tubes they might want to look into. 

    I'm so sorry you are having one thing on top of another....rare breaks inbetween.

    p

  • phrannie51
    phrannie51 Member Posts: 4,716
    #3
    So I did a search....

    typed in "profuse bleeding from a PEG tube".....and got this in a PDF article:

     

    Gastric Ulcer/Hemorrhage

    Bleeding that occurs after PEG placement is reported to complicate 0.3%–1.2% of cases (4,29,31,60). It is typically caused by peptic ulcer disease, traumatic erosion of the gastric wall opposite the internal bolster, or ulceration beneath the internal bolster.To reduce risk of ulcerations at the gastrostomy site, excessive lateral traction on the tube should be avoided (Figure 5). Inpost-PEG patients with upper gastrointestinal bleeding, endoscopy is tolerated well. During endoscopy, the mucosa under the internal bolster should be visualized by externally manipulating the PEG (35).

     

    I don't know how to post the link to it, because it opened up as a PDF article right from the search engine.  But I'm going to try anyway.  It maybe something to talk to the Dr. about.....sometimes they simply need help in figuring sh** out.

     

    www.medicine.virginia.edu/clinical/departments/medicine/divisions/ 

     

  • wolfen
    wolfen Member Posts: 1,324 Member
    #4
    phrannie51 said:

    So I did a search....

    typed in "profuse bleeding from a PEG tube".....and got this in a PDF article:

     

    Gastric Ulcer/Hemorrhage

    Bleeding that occurs after PEG placement is reported to complicate 0.3%–1.2% of cases (4,29,31,60). It is typically caused by peptic ulcer disease, traumatic erosion of the gastric wall opposite the internal bolster, or ulceration beneath the internal bolster.To reduce risk of ulcerations at the gastrostomy site, excessive lateral traction on the tube should be avoided (Figure 5). Inpost-PEG patients with upper gastrointestinal bleeding, endoscopy is tolerated well. During endoscopy, the mucosa under the internal bolster should be visualized by externally manipulating the PEG (35).

     

    I don't know how to post the link to it, because it opened up as a PDF article right from the search engine.  But I'm going to try anyway.  It maybe something to talk to the Dr. about.....sometimes they simply need help in figuring sh** out.

     

    www.medicine.virginia.edu/clinical/departments/medicine/divisions/ 

     

    Thanks, Phrannie

    You are so good at finding info for me. I never even thought to look this up. There I go trusting the doc who said, "I've never seen this happen before." I will definitely share this info with him.

    Hubby's not on blood thinners. Aspirin was removed from his meds in January, and ER doc said residual effects would be gone by now. BUT, ulcers ring loud and clear. His colonoscopy/endoscopy was last July. Funny, the throat cancer wasn't evident, but he did have about 5 stomach ulcers and even took meds for it. The stomach pain stopped, so we thought they were healed.

    I'm 99% sure we told the surgeon about the ulcers, but it's possible we didn't and/or maybe they are not healed.

    Luv,

    Wolfen

  • corleone
    corleone Member Posts: 312 Member
    #5
    wolfen said:

    Thanks, Phrannie

    You are so good at finding info for me. I never even thought to look this up. There I go trusting the doc who said, "I've never seen this happen before." I will definitely share this info with him.

    Hubby's not on blood thinners. Aspirin was removed from his meds in January, and ER doc said residual effects would be gone by now. BUT, ulcers ring loud and clear. His colonoscopy/endoscopy was last July. Funny, the throat cancer wasn't evident, but he did have about 5 stomach ulcers and even took meds for it. The stomach pain stopped, so we thought they were healed.

    I'm 99% sure we told the surgeon about the ulcers, but it's possible we didn't and/or maybe they are not healed.

    Luv,

    Wolfen

    Granulation tissue around the

    Granulation tissue around the stoma (skin perforation) bleeds easily, but shouldn’t be that much. Since there are no blood thinners involved, MDs should check if there is any coagulopathy, so some coagulation tests are also needed. Does he bleed easily (during tooth brushing, or small cuts, nasal bleeding)? Platelet number could be also low (thrombocytopenia), caused by chemo.

  • CivilMatt
    CivilMatt Member Posts: 4,724 Member
    #6
    Give Wolfen a break!

    Wolfen,

     

    I am with p51, good luck figuring it out.

     

    Happy Easter!

     

    Matt

  • wolfen
    wolfen Member Posts: 1,324 Member
    #7
    CivilMatt said:

    Give Wolfen a break!

    Wolfen,

     

    I am with p51, good luck figuring it out.

     

    Happy Easter!

     

    Matt

    Corleone

    Yes, he bleeds and bruises easily. There was a clotting factor test done at the last ER visit. I think it was 1.03. I have no idea what his platelet count is.

    I just discovered something else on Denis' thread. He's removing garlic from his meds for upcoming biopsy because of blood thinning factor. My hubby has been on garlic for a long time. I'll take that out of his meds today.

    His cardio gets nervous with no blood thinners in the mix, but we've got to hit a happy medium somehow.

    Luv,

    Wolfen

  • phrannie51
    phrannie51 Member Posts: 4,716
    #8
    wolfen said:

    Thanks, Phrannie

    You are so good at finding info for me. I never even thought to look this up. There I go trusting the doc who said, "I've never seen this happen before." I will definitely share this info with him.

    Hubby's not on blood thinners. Aspirin was removed from his meds in January, and ER doc said residual effects would be gone by now. BUT, ulcers ring loud and clear. His colonoscopy/endoscopy was last July. Funny, the throat cancer wasn't evident, but he did have about 5 stomach ulcers and even took meds for it. The stomach pain stopped, so we thought they were healed.

    I'm 99% sure we told the surgeon about the ulcers, but it's possible we didn't and/or maybe they are not healed.

    Luv,

    Wolfen

    You'd think when they

    sent that tube with a camera attached they'd have seen ulcers....tho maybe he's developed a whole new case since all this started....(I'm surprised you don't have them by now!!!).  The bleeding he gets gets is far and away a whole lot worse than the slight bleeding from granulation. 

    p

  • corleone
    corleone Member Posts: 312 Member
    #9
    wolfen said:

    Corleone

    Yes, he bleeds and bruises easily. There was a clotting factor test done at the last ER visit. I think it was 1.03. I have no idea what his platelet count is.

    I just discovered something else on Denis' thread. He's removing garlic from his meds for upcoming biopsy because of blood thinning factor. My hubby has been on garlic for a long time. I'll take that out of his meds today.

    His cardio gets nervous with no blood thinners in the mix, but we've got to hit a happy medium somehow.

    Luv,

    Wolfen

    The coagulation tests done
    The coagulation tests done routinely are: PT (Prothrombin Time) or INR (International Normalized Ratio), and PTT(Partial Thromboplastin Time). The INR is normally between 1 and 2 (if not on anticoagulants, or blood thinners), that’s what the 1.03 could be. Anyway, the idea is to have checked these tests (including platelets); these are required before any minor (not to mention major) surgical procedure. Might be requested for regular checkup, but the standard of care differs from one Hospital to another. If all tests normal, than should focus on some local issues, around the stoma, causing too much mechanical strain.
  • Skiffin16
    Skiffin16 Member Posts: 8,305 Member
    #10
    phrannie51 said:

    So I did a search....

    typed in "profuse bleeding from a PEG tube".....and got this in a PDF article:

     

    Gastric Ulcer/Hemorrhage

    Bleeding that occurs after PEG placement is reported to complicate 0.3%–1.2% of cases (4,29,31,60). It is typically caused by peptic ulcer disease, traumatic erosion of the gastric wall opposite the internal bolster, or ulceration beneath the internal bolster.To reduce risk of ulcerations at the gastrostomy site, excessive lateral traction on the tube should be avoided (Figure 5). Inpost-PEG patients with upper gastrointestinal bleeding, endoscopy is tolerated well. During endoscopy, the mucosa under the internal bolster should be visualized by externally manipulating the PEG (35).

     

    I don't know how to post the link to it, because it opened up as a PDF article right from the search engine.  But I'm going to try anyway.  It maybe something to talk to the Dr. about.....sometimes they simply need help in figuring sh** out.

     

    www.medicine.virginia.edu/clinical/departments/medicine/divisions/ 

     

    Is This The Link

    LynchArticle

  • wolfen
    wolfen Member Posts: 1,324 Member
    #11
    Skiffin16 said:

    Is This The Link

    LynchArticle

    Hi, John

    Yep, that's the fast way to it. I found it through Phrannie's link and then to the medical dept. tab at their website. I made a copy of the section Phrannie put on here to show the doc.

    Oh, and to Corleone, I forgot to say hubby has had no chemo yet. I know about chemo and low platelets from my daughter's experience, but will see if other blood issues have been checked.

    THanks,

    Wolfen

  • Tim6003
    Tim6003 Member Posts: 1,514 Member
    #12
    corleone said:

    The coagulation tests done
    The coagulation tests done routinely are: PT (Prothrombin Time) or INR (International Normalized Ratio), and PTT(Partial Thromboplastin Time). The INR is normally between 1 and 2 (if not on anticoagulants, or blood thinners), that’s what the 1.03 could be. Anyway, the idea is to have checked these tests (including platelets); these are required before any minor (not to mention major) surgical procedure. Might be requested for regular checkup, but the standard of care differs from one Hospital to another. If all tests normal, than should focus on some local issues, around the stoma, causing too much mechanical strain.

    Man oh man ....you just keep getting the hits!!

    Sorry about this latest one Wolfen ....

    Lot's of good feedback, so I will leave it as I often do, said my humble little prayer for some peace and quiet on the front for a bit ...that you and your husband can actually find a distractment from all that is going on, a good distractment.

    On a silly note to that (but serious if you like) you can always take a road tirip and come visit me in my peice of paradise...got a room fro you a the hotel and a comp breakfast to go with it ...heck, we even got biscuits and gravy!! :)

    Prayer wa sent ...keep us posted.

    Tim

  • wolfen
    wolfen Member Posts: 1,324 Member
    #13
    Tim6003 said:

    Man oh man ....you just keep getting the hits!!

    Sorry about this latest one Wolfen ....

    Lot's of good feedback, so I will leave it as I often do, said my humble little prayer for some peace and quiet on the front for a bit ...that you and your husband can actually find a distractment from all that is going on, a good distractment.

    On a silly note to that (but serious if you like) you can always take a road tirip and come visit me in my peice of paradise...got a room fro you a the hotel and a comp breakfast to go with it ...heck, we even got biscuits and gravy!! :)

    Prayer wa sent ...keep us posted.

    Tim

    Thanks For The Invite, Tim

    I don't know exactly where you are in Idaho, but you can't be too far away from my favorite place, Grand Teton Nat'l Park. I spent 3 summers there as a kid, learning what the shovel at the stable was for.  LOL  Actually, I graduated quickly to Trail Ride Guide for the tourists. I never forgot those fun times and after 50 years, hubby & I splurged & took a vacation there. They say you can never go back. The scenery was still beautiful, but Colter Bay, my old stomping ground, and the town of Jackson are so different now. Kind of broke my heart. Downtown Jackson reminds me now of Scottsdale, where I live. Just expensive tourist traps, but with beautiful scenery.  LOL

    As for a distraction, I realized we have a good one coming up. In May, our son will be graduating from college with 2 degrees in Arts and in Science. He has always been a 4.0 + honor student, on the dean's list and got a letter inviting him to give a commencement speech.  I'm very proud of him. He has been a single parent since he was 16 years old. We tried for years to get that dang "kid" to go to college. With his scientific mind and love of the forest, his greatest desire is to work for the Forest Service in some type of Environmental Science. I hope his dreams come true.

    I LOVE BISCUITS AND GRAVY!!!

    Luv,

    Wolfen

  • Tim6003
    Tim6003 Member Posts: 1,514 Member
    #14
    wolfen said:

    Thanks For The Invite, Tim

    I don't know exactly where you are in Idaho, but you can't be too far away from my favorite place, Grand Teton Nat'l Park. I spent 3 summers there as a kid, learning what the shovel at the stable was for.  LOL  Actually, I graduated quickly to Trail Ride Guide for the tourists. I never forgot those fun times and after 50 years, hubby & I splurged & took a vacation there. They say you can never go back. The scenery was still beautiful, but Colter Bay, my old stomping ground, and the town of Jackson are so different now. Kind of broke my heart. Downtown Jackson reminds me now of Scottsdale, where I live. Just expensive tourist traps, but with beautiful scenery.  LOL

    As for a distraction, I realized we have a good one coming up. In May, our son will be graduating from college with 2 degrees in Arts and in Science. He has always been a 4.0 + honor student, on the dean's list and got a letter inviting him to give a commencement speech.  I'm very proud of him. He has been a single parent since he was 16 years old. We tried for years to get that dang "kid" to go to college. With his scientific mind and love of the forest, his greatest desire is to work for the Forest Service in some type of Environmental Science. I hope his dreams come true.

    I LOVE BISCUITS AND GRAVY!!!

    Luv,

    Wolfen

    You are correct....

    I live in McCall, Idaho ...just 100 miles north of Boise ...and oh boy would your son love working for the forestry service up here!!! :)  Plenty of forest!

    I often refer to our little 3,000 person town as the unknown "Lake Tahoe or Jackson Hole" bc it is just a beautiful, but nobody knows about us.  The town is TOTALLY against a commercial airport for that reason, keeps the toursits out. Heck, if you are from California the towns folks don't like you much either (sad but true)...they really are protective over this little town.  No name brand chains allowed.  So we have no McDonlalds, no Wal~Mart, heck, no nothing that is a chain or franchise ...all have to be mom and pop...but we sure do have some good eat'n here in our little town. :)

    Keep us posted.

    Tim

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