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Managing Other Symptoms |
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 Digestive
System Problems
Digestive system problems are common in very sick people. Some of
these problems are related to symptoms of disease. Others are related
to medications. All are best prevented, or treated early, rather than
letting them get to the point of making you uncomfortable.
 "I
just can't eat"
Many people find that they have no appetite, and that forcing oneself
to eat is not pleasant. Usually you are best advised to follow your
instincts. Try small amounts of any appealing food. Also, recognize
that food is often important for its symbolism (of home, friends,
and traditions) and its bringing people together socially, rather
than for its nutrition. Unless particular foods or salt make you sick,
when you are close to the end of life, eat what you want, not what
someone thinks you should.
Nausea/vomiting
You may have nausea and/or vomiting because of certain medications,
constipation, or bowel obstruction. If your medication is the cause,
you should ask your doctor about changing your medicines, or adding
an antiemetic, to reduce nausea. Constipation can cause nausea and
vomiting, so treat it promptly. Sometimes an imbalance in blood chemistry
is the problem, so your doctor may need to run blood tests.
Constipation
Constipation is commonplace and very uncomfortable. With limited liquid
or food intake, little activity, and various medications, it is no
wonder that your bowels may be sluggish. Constipation can cause abdominal
cramping. Talk to your doctor or nurses about using stool softeners,
laxatives, and enemas to relieve constipation, especially if you are
taking opioids. Always try to prevent constipation. Relief of constipation
can improve comfort, even during late stages of dying.
Bowel
obstruction
Your bowels can get blocked sometimes, especially in abdominal cancer.
If you might have many months to live, doctors will advise surgery.
However, if you are close to the end of life, you can stay quite comfortable
without surgery, usually by using medications to slow bowel contractions
and other means to prevent stomach overfilling, as needed. A little
pathway may open up, perhaps with some help from steroids, so that
fluids can be absorbed normally.
If vomiting due to bowel obstruction is uncontrollably severe, a tube
can be placed through the abdomen into the stomach so that stomach
juices can drain without being vomited. This is called a "venting
gastrostomy" and can be done under light sedation. Unlike a "nasogastric
tube," a venting gastrostomy tube does not stay in the nose and throat
causing pain and irritation. Although a bowel obstruction may be a
final complication in the days before death, dying this way can usually
be made comfortable.
A Case Study
Mr. Horace Black came to an in-patient hospice with widely spread
cancer and a stomach obstruction. He had a plastic tube threaded through
his nose to his stomach. To suction his stomach, the tube was hooked
to a vacuum pump. He was quiet and resigned. He had almost no family
left, only a sister living in a nursing home nearby.
The hospice nurse asked him if he'd like to try going without suction.
He was incredulous that this might be possible and talked with the
doctor, who noted that removing the tube might actually be preferable.
The worst that might happen would be some vomiting (and that the tube
could be replaced). In fact, if he wanted, he could take a little
food and drink.
A few hours later, tube gone, Mr. Black sipped a little fresh orange
juice. Then this very reserved man called his sister and was overheard
to say, tears running down his cheeks,
Rose, I'm alive again! Either that or I'm already in heaven! I'm
free of that awful sound, and I'm actually tasting juice. Life is
so sweet!
Things went well for him. He had little appetite but enjoyed small
tastes of favorite foods. He died peacefully ten days later. |
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Adapted from The
Handbook for Mortals: Guidance for People Facing Serious Illness,
by Joanne Lynn and Joan Harrold, copyright by Joanne Lynn, used by
permission of Oxford University Press.
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