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Suggest Treatment For Pain In Lower Left Quadrant Of Abdomen And Nausea In An Elderly Person

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Posted on Wed, 24 Jun 2015
Question: My Father is 89 1/2 years old. He has a LOT of LLQ pain (I'm in the Biz myelf but am at my wit's end!) Also, has a lot of nausea. He is known to have multiple fishmouth diverticuli by colonoscopy last year, but no history of bleeding, peritonitis fever high WBC or etc. Maybe SUDD?? He sometimes complains every five minutes or so and I am the sole caregiver. He's a "Gomer" too but is walking, talking and continent. Meds are bentyl BID prn, Asacol (my idea) BID-TID prn, pepcid, BID, zofran TID for the nausea, currently on cipro/flagyl for one week as per urgent care. Also takes Benemid and I put him back on Exelon patch 4.6 for his memory (probably doesn't DO squat, I know. I can take it up to 9.8 OR D/C it if you feel it's making the GI stuff worse) He has a history of IBS and hemicolectomy for colon cancer almost twenty years ago. I have not advanced his fiber except for Benefiber in the AM and veggie chopped liver on bread for lunch, because it just seems to constipate him. His social history BTW is rare EtOH, quit cigars in 1989, and he used to eat oatmeal for breakfast frequently, had a piece of fruit and peanuts with lunch and salads with dinner. He has not had this for awhile. Also, he had a pretty bad case of shingles lasting from February 2014 through April and still has the neuralgia. This put him on his back and seemed to have triggered the Diverticulosis.

HELP!!

Thanx,
XXXXXXX
doctor
Answered by Dr. T Chandrakant (19 hours later)
Brief Answer:
Let us stop/reduce unnecessary medicines.

Detailed Answer:
Hi.
Very nice to meet a person taking so much care of an ailing elderly Father.
Read and re-read the history you have provided.
I think you have been taking proper care and the medicines He is taking are optimal.
Yes, first of all stop Flagyl if one week is over.
you ma continue Cipro for a longer duration (the only precaution is to drink more water with Cipro).
He should receive Probiotics daily.

Since he is a known case of operated Ca colon and fish mouth diverticuli, some or the complications can occur anytime. It is good that there is no bleeding, peritonitis, fever or high WBC- SUDD is always a possibility.
It is natural for him to be gomer.
Noted the Medicines:
Bentyl - Dicyclomin can be given on SOS basis (if pains in abdomen as it slows the bowel movements too)
Asacol - Mesalamine Thisis an anti-inflammatory working on intestines, mainly6 taken in cases of ulerative colitis.
Pepcid -Continue if required.
Zofran -ondansetron centrally acting for nausea and vomiting
Benemid - probenecid - Why is this given ?
Exelon Patch (rivastigmine transdermal system) contains rivastigmine for
Also noted other history you have provided.

Shingles at this age,; it is really troublesome as far as the pains go.

I think we should keep him on the least possible medicines so that he can have better life.
Too many medicines do cause drug interactions, adverse effects, that all are not listed or noted anywhere.

I hope this answer helps you.
Please feel free to ask relevant queries if you need to or if you feel that there is a gap-of-communication (we are in the virtual world)



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (2 hours later)
Thank you for your detailed reply. I'm in the Business myself but to have me is to have a Fool for a patient (and more relevantly, a Doctor ((-;)

I give the Bentyl only BID prn-It probably also increases the confusion. Dad repeats himself a LOT, especially when he does not feel good. That makes life hard for Me as the sole caretaker. He does have a Geriatrician. He was on Adderall for alertness also, but the Geriatrician had me Discontinue this, as he is somewhat underweight at 5"9" and 150 lbs (he used to be 190 lbs two years ago.) The Geriatrician prescribed namenda, but I have kept him off this, at least until he feels better. A Neurologist we stopped going to believes in Exelon, so I put him back on the 4.6mg, and am contemplating increasing to 9.8 tomorrow, unless you think that will ruin his digestion more. I know all to well these meds have limited effectiveness. I make him fried eggbeaters for dinner when he is feeling unwell. I could fry it in coconut oil and a bit of cumin-seriously-those things may Help or at least prevent mental deterioration in some folks. I just gave him a small piece of "medicated" cake with marijuana. I think I saved his Life with hash brownies a year ago when the Diverticulosis symptoms became difficult to manage. Other than tylenol, I guess we are limited in what to do for the pain. Narcotics constipate, steroids and NSAIDs could burst the diveriticulae. Any advice you have about that would be most welcome, as he is holding his llq and saying "it hurts!" I have used a heating blanket on the area in the daytime. Don't know if I mentioned that.The Benemid is for the usual reason of a remote (40+ years ago) attack of gout in the Great toe. If he were off the med and this were to happen again, he would be fit to be Tied! I also have made chia seed gel to put in his jello and yogurt. He doesn't currently Like the all liquid broth jello etc diet. He was eating mashed potato flakes in chicken broth and drinking hot tea when I first came to take care of him a year and a half ago. Poor appetite at the time, but did not have the classic type belly pain then.

Again, Thank you for your advice.
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
Please continue.

Detailed Answer:
Thanks for your splendid feedback, impressed with the care you are taking, the medications and all.
The old person needs the least medicines; personal care works far far better than any known medicines.

Yes, this diverticulosis/diverticulitis keep everyone on the toes, Do not worry, it may not trouble as the body also has its own ways of healing and talking the problems.
Please carry on as it is.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. T Chandrakant (51 minutes later)
PSS:

His GI last year who did the colonoscopy (and endoscopy) had him on lactulose syrup. I still have some, but the Benefiber AM and Miralax PM seems to control the constipation. If I could only find liquid Beano around here I could give him broccoli, etc. The GI warned about foods that provoke Gas.
doctor
Answered by Dr. T Chandrakant (25 minutes later)
Brief Answer:
as discussed

Detailed Answer:
The character of the laxatives:
One should go on changing one by one so that the patinet does not become dependent one a single one.
Secondly, the requirement of all the laxatives is totally person dependent, meaning everyone's response, the dose and effectiveness is different.
Thirdly, about the foods: Again a particular food may be very suitable for one and cause a problem to another. What suits your Father will be either told by him or is going to be your observation. Hence this is going to be a permutation and combination.

I hope this answer helps you.

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 19780 Questions

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Suggest Treatment For Pain In Lower Left Quadrant Of Abdomen And Nausea In An Elderly Person

Brief Answer: Let us stop/reduce unnecessary medicines. Detailed Answer: Hi. Very nice to meet a person taking so much care of an ailing elderly Father. Read and re-read the history you have provided. I think you have been taking proper care and the medicines He is taking are optimal. Yes, first of all stop Flagyl if one week is over. you ma continue Cipro for a longer duration (the only precaution is to drink more water with Cipro). He should receive Probiotics daily. Since he is a known case of operated Ca colon and fish mouth diverticuli, some or the complications can occur anytime. It is good that there is no bleeding, peritonitis, fever or high WBC- SUDD is always a possibility. It is natural for him to be gomer. Noted the Medicines: Bentyl - Dicyclomin can be given on SOS basis (if pains in abdomen as it slows the bowel movements too) Asacol - Mesalamine Thisis an anti-inflammatory working on intestines, mainly6 taken in cases of ulerative colitis. Pepcid -Continue if required. Zofran -ondansetron centrally acting for nausea and vomiting Benemid - probenecid - Why is this given ? Exelon Patch (rivastigmine transdermal system) contains rivastigmine for Also noted other history you have provided. Shingles at this age,; it is really troublesome as far as the pains go. I think we should keep him on the least possible medicines so that he can have better life. Too many medicines do cause drug interactions, adverse effects, that all are not listed or noted anywhere. I hope this answer helps you. Please feel free to ask relevant queries if you need to or if you feel that there is a gap-of-communication (we are in the virtual world)