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Handbook for Mortals : Managing Other Symptoms

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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