My husband is 88 and in good health. He has a colon abscess that has not responded to antibiotics (levaquin and flagyl) although the antibiotics have made his symptoms diminish considerably. He has not had this problem before. We worry, obviously, why the abscess has not diminished while the symptoms have diminished. Can an abscess ward off the effects of antibiotics?

His doctor and his surgeon say he has to have an open resection surgery next week. His surgeon says his colon looks "pretty good" above and below the diseased section and expects to be able to rejoin the sections during the surgery. The surgeon says a laparascopic procedure is not possible and the surgery must be an open surgery. We are obviously concerned and would appreciate any information (and encouragement) those who have experienced similar surgery/treatment can offer.

My husband is not tolerant of pain. He had a radical prostectomy in 1992 and remembers the pain vividly. We would appreciate any input on pain management you may have to offer.

Thank you.

Lorraine Gayer

I assume by absesses you are refering to divertuculum. I had a bowel resection similar to the one your husband is refering to in Nov 04.

Some years before a divertulum had aparently burst, and then become very infected and joined my prostate and evetually perferated my bladder. During the 5 years that this had been happening I suffered from prostate pains and symptoms and later bladder infections, problems passing water and inflamation of the bowel. I was even disgnosed and treated for Crohnes Colitus. The extend of the inflamation and correct diagnosis only became apparent following surgery.

As far as pain relief is concerned, you can and should do something about it. You do get used to a certain level of pain but there are things you can do and drugs you can take to help. Pain is very real. My experience was that some nurses would behave as if you were creating a nussance id you were constantly saying, "I am in pain". One of my biggest frustrations was no one seemed to take me seriously and although my specialists were great my gastrioenterologist would not give me any pain relieve until I was diagnosed with the fistula (join between bowel and bladder - not nice!). Instead she told me to take paracetomal, which did not even go close. Palliative care is shockingly bad in this country (I cannot speak for other countries). The level of pain you feel is personal to you and very real. Of course there are things you can do to relax like breathing exercises, and visualisation techniques. But as you will know there is nothing worse than waking in the middle of the night in very severe pain, and feeling so alone, and not wanting to wake up your wife because she needs her sleep and you woke her up twice the night before!

Just before going into surgery your husband will probably be put on an epidural, which is essentually a drip on morphine fed directly into the spinal collumn which will cut off all feeling from the chest to the knees. This normally stays in place for two to three days, and following this he will then be given morhpine or other less strong opiates. The epidural is very effective (although very wierd). I have to be honest and say that the operation is very major and with involve a lot of discomfort following it as well as a faily long recuperative period.

The best pain relive except for morphine in my opinion is tramadol. It is one level above cocodomal in opiate strength which and I believe just one notch below morphine. It is a synthetically created drug so does not have the disadvantages that morphine has (you cannot get a physical addiction to it). It might make him a bit drowsy, so I used to take only one when I was working as it meant I could still drive and mostly concentrate at work, and it took the edge of the pain. All analgecs will slow the bowel to some degree and therefore give some constipation, but tramadol does this less than most (and certainly less that codiene). You can also take it with paracetomol to increase its strength (I only found this out when the nurses were giving it to me while in hospital). I used to take one tramadol (50mg) and 2 paracetomal every 4 - 6 hours during the day and then 2 tramadol and 2 paracetomal the minutes that I got home from work. 2 tramadol will send you away with the fairies, but should remove all pain (you will feel pain but not care). Whatever he does he should stay well clear from ibruprofen, as it irritates the large bowel and will make him feel far worse. If you do get a prescription for tramadol and are later admitted to hospital make sure that you tell the anaesthetist what dose you have been taking and for how long as you will have built up some resistance to morphine and so he or she will need to give more than normal to ensure that he does not wake up after surgery in pain.

I think that the most inportant thing is to produce a list of qustions for both the surgen and the anaesthetist and ensure that they answer each one to your and your husbands satisfaction. Then following the operation ensure that your husband takes it very slow for several months

Mischa

Lorraine,
Unless it is absolutely necessary -- by that I mean life theatening I would not do it! I know this is not encourageing. It just comes with too many risks at your husbands age.

I think any abdominal surgery is painful and comes with all sorts of possible problems. I think you need to be extremly well prepared if you decide to proceed. I agree you need to ask questions that you may not even know to ask now.

Also, all pain medication causes constipation to some degree.
And, with colon surgery make sure that you know to use fiber therapy and a stool softner so as not to get constipated-- talk with your Doctors about how it and the nausea is going to be handled--- the food that he can and can't eat or drink because It will all be a big problem after surgery. Liquid diet, soft diet and regular diet.

Not only that -- he will probably be given antibiotics that can cause diarrhea at first-- it just goes with this type surgery.

I had 2 1/2 feet of my colon removed on 3/4/2002 because of chronic diverticular bleeding. It was an open procedure and very painful. The incision cuts through all your abdominal muscles-- from the center of my rib cage to the pubic area.

I did not take any oral pain meds after the pain pump morphine was used up because --of possible constipation problems and never did.

Also, I was only suppose to have a smaller section of my colon removed because of 1 bleeding diverticular. The surgeon warned me that they never know the colon's condition until the operation -- some sections can be thinning just due to ageing along with unknown diverticlar pockets -- so my entire sigmoid colon and then some was removed. On the 4th day after surgery-- I had diarrhea every half hour to 45 minutes for 12 hours-- and needed help getting out of bed --- 6 staples came loose and I had a open wound for 6 weeks.

I was sent home the next day -- the 5th day after surgery.

I believe that optimum health begins in the intestines-- because all required nutrients are absorbed there-- a malfuntioning digestive system just causes all sorts of problems.

I have used homeopatic medicines for 35 years and that was my salvation.

God Bless You Both ~~~Harry

Lorraine

I think that Harry has made some really good points - you should explore all medical options before deciding on surgery.

good luck

Mischa