# Impacted again



## Stevect06 (Jun 20, 2014)

I was in the hospital again last week - the 3rd time since December 2013 due to impaction. Like before, an x-ray was done that showed a possible obstruction, then for a clearer view a cat-scan was ordered which concluded it was impaction. Unfortunately, like the previous times it was up high, likely in the transverse colon or before. Like when I was treated in June, an enema was done to clear it. Not a fleet enema, but the type with a hanging bag with a tube (what's that called?) to get the fluid up where it was required. In June it occurred because I stopped Miralax that I was taking, to try Linzess. which was recommended. For some reason Linzess didn't work for me and I've been back on Miralax once a day since. I was so disappointed and concerned since this episode happened while on Miralax. Now per the G.I. doctor I'm on Miralax twice a day. Been going since, not a lot but then again I was so cleaned out in the hospital it would have been a good day for a colonoscopy if you know what I mean. Stools aren't normal, but at least things are moving along.

I'm scheduled for a visit with the (new) G.I. next month. I had a colonoscopy a year ago (my first), a couple of good sized polyps were removed which isn't unusual for my age 57. The new G.I will want another colonoscopy. What I wonder is why do I keep getting impacted? I've always eaten well, very little if any red meat, a diet favoring vegetarian. I have some fruit every morning, drink plenty of fluids, good fiber intake, etc. I'll try anything - although I love fruits and vegetables maybe I should back off a bit? I've been keeping a log - one possible common item may be beans and rice, even brown rice before I get impacted. That may not make sense - but that's typical of me not being with the mainstream.

Usually after eating anything I get all kinds of 'turbulence' - abdominal noises, gurgling, popping, etc. But not so much since I've been discharged. Since Sept. 2012 to Aug 2014 I've lost 29 lbs. without trying, about 18 of those in the last 10 months. Crazy what's been going on. Except for the weight loss I've never had any G.I./digestive system trouble before December 2013.


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## annie7 (Aug 16, 2002)

so sorry for all your problems. yes, it's miserable being impacted, isn't it.

are you taking any medications that have constipation as a side effect?

have you had your thyroid levels checked recently? low thyroid levels can cause constipation.

it's a good thing you are going to see a new gastro doc. hopefully he/she will be proactive in finding what's going on with you.

you might want to ask for a sitz marker test (colonic transit study)if your gastro doesn't suggest one. it could be that you've developed slow transit constipation (colonic inertia). do an internet search for more information. my sitz marker dx'd very slow transit. my colon simply does not work on it's own. if i don't take stimulant laxatives--as well as milk of magnesia--i don't have a bm at all. my gastos and surgeon have all told me to take whatever i need to go. osmotic laxatives alone do not work for me--they just sit in my colon, going nowhere. i need a stimulant to push it all out.

for those of us with slow transit, fiber is not our friend. i find i do much better with a diet low in fiber. you might want to adjust your diet anyway--even without testing--just to see if that helps. no way can i eat rice. it's so starchy--plugs me right up. brown rice is also quite high in fiber. i also eat a low FODMAP diet (google it) which helps prevent gas and bloating. there's lots of good diet info on the diet board and elsewhere on these boards.

as we get older (i'm 62) our digestive system and the colon tend to slow down a bit so the recommended amount of fiber in our diets also becomes lower.

good luck. hope your new gastro doc has some answers for you and a treatment plan that will work for you.


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## Stevect06 (Jun 20, 2014)

Thanks for the very interesting and informative reply. Many similarities I see. "yes, it's miserable being impacted, isn't it." ... yep - hate when that happens. Started to feel quite sick. Many have asked my about the thyroid test, I had a blood test in June, the doctor's (not G.I. doctor) office said it was included in the test with normal results. I wish I knew what the abbreviation was - I have a copy of it. I'm not taking any medications that could cause constipation.

The sitz marker test I believe was one of the tests recommended. I do believe I have a slow transit situation. A few weeks ago I took one laxative tablet, it wasn't until 3 1/2 days later that I noticed any result, but I can't say for sure it was related. Back in December when they sent me home with 'Golytely', I was told to be prepared for quick results. Nothing happened until 9 1/2 hours later! So high fiber can certainly have a negative effect..I certainly will cut down. I was going to anyway - but apprehensive not wanting to make things worse, but now I see a legitimate reason. I know this forum is just for advice, but actually reading something I've believed could be a factor is reassuring. Interesting to see rice could be a legitimate suspect as well. Being that starch is the culprit, should potatoes also be a concern?

I previously investigated the FODMAP diet. Before this latest bout the discomfort (gas, bloating) level improved, and I actually gained 2 lbs. One thing I almost eliminated was something I love - onions. Hard to say if it was a coincidence or not. I'll still eliminate them for now. It seemed bizarre making a pizza without onions. I'm back to using soy cheese, don't want to take a chance with dairy cheese.

Sorry to hear about what you're dealing with as well, glad to see you've identified what can help you. That seems to be the key with this aliment - we're on our own to a certain extent. The more research I do I learn that everyone is different, so we have to research and test ourselves. I haven't researched milk of magnesia to see if long term use is ok.

I appreciate the terms you've given me to research that certainly sound related to my situation. Even though I've been researching online for a while, I don't recall terms such as colonic inertia standing out.


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## annie7 (Aug 16, 2002)

osmotics like golytely don't work at all for me, period. i have to take at least 3 or 4 dulcolax as well in order to kick them out. otherwise all that osmotic lax just sits there in my colon, sloshing around....

one laxative tablet never did anything for me, either. i have to take the max dose. my current laxative regimen is with my gastro docs' and surgeon's approval, of course.

yes, we're all different when it comes to diet and FODMAPs etc and what affects us. i've found that onions actually are ok for me, which is good.  i love them too.

about starch and how it can affect constipation. another board member, Tummyrumbles, has posted a lot of terrific food info on the diet board as well as on this and other boards. and also on the research board ("ibs news, media, research results, discussion and abstracts") . one of the things she mentions is how starch can cause gas and bloating and how that can increase constipation. here is one helpful link to one of her postings.

http://www.ibsgroup.org/forums/topic/184490-starch-fibre-fodmap-ranking-of-common-foods/

as far as potatoes are concerned, she told me red potatoes have the lowest starch content. i googled it to find out the specifics.


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## Stevect06 (Jun 20, 2014)

Lucky you with the onions! Glad you can have something you enjoy. Hard to say if it's a factor with me or not. Since I got out of the hospital Thursday I haven't had the typical discomfort after eating - still omitting onions for now. Thanks for the link re: starch. Today I was low on white bread, went to the store which had a buy one get one sale - bought a loaf of white and potato. Both, I was pleased to see, had < 1 gram of fiber per slice. Seems ironic saying that's good... I was going to buy gluten free, but the white breads I saw were rated at 2 grams per slice.

I was convinced that Golytely would have done nothing for me in the hospital. I was relieved when I stated that to the E.R. staff - and they said that wasn't part of the plan. With an impaction logically it would just sit there. They tried that in June, I told them it's not gonna work - about an hour and a half after taking it they discontinued it (was being administered via a tube down my throat since I couldn't drink any more after drinking all the cat scan contrast!) and did the enema for a cat scan (forgot the term) - which ended up being the cure to free the high up impaction.

Been doing a lot of research today about fruits low in fiber - I like fruit and would prefer not to totally eliminate it, but will absolutely cut significantly down in fiber intake overall. The remaining rye bread I have will go outside for the birds. As you said I found a lot of cautions and advice about restricting fiber if a slow transit situation exists. A catch 22 about watermelon - it's low in fiber but on the FODMAP list as something to avoid. Currently I think it's more important to make sure everything keeps moving, so I'll favor the low fiber attribute and maybe put up with some temporary discomfort. These situations sure can become complicated!

I wonder how you do with beans? Before this latest episode I made bean burritos and brown rice. In December, when it first occurred, I had a lot of vegetarian chili that I made, with beans and rice.


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## annie7 (Aug 16, 2002)

oh yes, the diet thing is complicated.

and yes i do agree with you that the most important thing for us C people is to just keep things moving. watermelon could very well help you with that since it is low in fiber and has a high water content and lots of vitamin C. so yes, i would go with the watermelon, especially if it helps. the low fodmap diet is supposed to help reduce gas and bloating but not all the foods listed in it affect everyone exactly the same way. so yes, it pays to experiment to see what works for you, what FODMAPs you can tolerate better than others and most importantly what helps move things along.

good nutrition has always been a huge concern of mine, even more so now that i'm getting older. i certainly didn't want to just avoid eating everything on the FODMAP list because that's just not healthy. so i experimented a lot and found which foods i can eat and tolerate better than others. i've always thought working with a registered dietitian or nutritionist can be a great idea. but it is expensive unless insurance covers it.

beans have always made me extremely gassy so i avoid them all with the one exception of green beans. no gas. they're great  (for me, at least)


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## Stevect06 (Jun 20, 2014)

I'm glad you concur about watermelon. Next time at the store I'll get some as I have been all summer. I've been keeping a food log. Now I realize it's even more important to continue with even more details - as you said experimentation is key.

On a different note - I had a stroke in 2002. Since then I've been eating low/no fat, same with sodium. I'll eat meat occasionally, I've had 2 real cheeseburgers this year. I like Morningstar and Boca products. But, since losing almost 30 lbs in 2 years, about 18 of them this year without trying I believe I'm a pound or two underweight. So, for the first time in years I bought 'real' ice cream, not reduced or no-fat. (Breyers no-fat vanilla is fantastic) The Breyers vanilla was No Sugar Added though, - I had to make it at least partially healthier. Same with other foods and sacks, buying the standard item. I know now there could be another complication from those - the 'C'. I did have a ham sandwich for dinner with a slice of regular provolone cheese. I wonder of I should go back to the imitation, soy based cheeses that I have on hand since cheese should be a concern.

It's catch 22 again - I should gain some weight (it sure sounds weird saying that!) but in doing so I may be risking getting constipated, or impacted. We're in the same boat with green beans - and pleased about that. I still have those growing in the garden - and they're so good.


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## annie7 (Aug 16, 2002)

oh dear---so sorry about the stroke. what a difficult ordeal. i do hope you've made as full a recovery as possible.

i can certainly understand why you now want to eat low fat. my husband has heart problems--three stents. he eats low fat. he likes Beyers no-fat ice cream too.

when he eats cheese, he eats the no fat cheese. or low fat sometimes. i sometimes eat cheese (no fat/low fat) but too much of it binds me up.

are you able to eat any of the healthy fats--such as olive oil, canola oil, etc?

for me--and i've read this and heard others say it too--having some healthy fat in my diet has helped combat constipation. fat helps trigger peristalsis. i used to eat very low fat but then i did some reading and experimented and found that a bit of healthy fat does help me go better. it's especially helpful in the morning. i have a warm breakfast with a bit of healthy fat and black coffee--coffee helps give me an urge also. so the combination of all this really helps me go in the morning. no breakfast, no coffee e--no urge...

i'm way underweight... because of C. it's hard to eat when i'm having a bad day-- way bloated, nauseous and C-- but i learned to force myself to eat many many years ago.

yes--love those garden vegetables. my husband has a big garden. the bean crop was terrific this year. he froze lots of them.

yes, it sure is a catch 22 isn't it. quite the balancing act.


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## Stevect06 (Jun 20, 2014)

Sorry to hear about your husband's ordeal. Sounds like he's familiar with a lot of the foods that I am. Fortunately I have very few lingering side effects from the stroke.

Ironically this G.I situation has caused is an improvement in that health aspect with me - cholesterol and blood pressure. Since losing so much weight, the numbers are down to good levels, even when not taking medication.

It seems logical that some healthy fat would be beneficial. Black coffee is the coffee I drink. Only this week I added honey a few times after reading that it could help with C - but I've also read otherwise, so the jury is still out on that. I should have a breakfast like you - mine is toast and (was) some fruit. Cutting down on the fruit based on information this week.

Thanks for the information and tips so far. Even though I have an appointment with a specialist next week it's good to know as much as possible to prevent what happened last week.


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## annie7 (Aug 16, 2002)

that's wonderful that your cholesterol and blood pressure numbers are down--good for you!

yes, i tried the honey thing. it didn't work for me but it's worth a try. we're all so different in how our bodies react to things. what works for one may or may not work for another but i feel anything is worth trying as long as it doesn't adversely affect my other health problems of course.

some people have also said blackstrap molasses can help stimulate a BM. tried that too...

yes, do try to eat a larger breakfast if at all possible. a decent sized warm breakfast with some healthy fat in it does stimulate peristalsis. especially because it is eaten after an overnight fast. most people's bowels are most active in the morning, after they get up, and the good breakfast really helps with that. i've read this and my docs and biofeedback PT all told me this too. it definitely helps me go.

good luck with your appointment next week. let me know how it goes, if you get the chance--thanks


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## Stevect06 (Jun 20, 2014)

Thanks for asking about the follow up, unfortunately my appointment was cancelled due to the doctor having to do surgery which I understand. If it was for a fishing trip or golfing I would have been annoyed. Rescheduled for next week.

Sorry - I realize I didn't answer a previous question. I seem to be fine with healthy fats/oils, in fact I've been increasing the amounts of those a bit lately. Thanks for the molasses tip. Did that not work for you?

In the mean time things have been working adequately being on Miralax twice + - a day. Seems like restricting fiber certainly isn't hurting, may be helping. I noticed after eating pretzels I get some rumbling down below - so I did buy some gluten free pretzels and white bread. Didn't seem to get the same reaction after eating those, but it's hard to say whether gluten free was a factor or not. I'd think it would be great to find a contributing factor for all the issues, on the other hand I sometimes hope it's not gluten because I happen to find gluten free foods not that appealing, and they're expensive! Tests early this year didn't show a sensitivity to gluten - but I've read others who don't have celiac disease have benefitted from a G.F. diet in other ways.

I am pleased that things have been consistently happening in the morning. Overall the frequency and other related factors are different from a year ago, meaning normal for me - but if I had to stay on Miralax once or twice a day with this pattern then so be it. I'll accept that if I knew I wouldn't become impacted again. Haven't had a bit or rice or beans - reviewing my meals document they seem to be involved with things slowing down - and stopping.

Speaking of a warm breakfast - last Saturday I had my first soft boiled egg in 12 years! Since my cholesterol has been good, I certainly don't think a whole egg will hurt once in a while. The egg was wonderful. What a nice breakfast it was with toast. Fortunately I have an ex who has been good to me, she gave me the egg from one of her chickens!


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## annie7 (Aug 16, 2002)

oh that's disappointing about your gastro appointment but yes, like you said--it was rescheduled for a good reason. and at least it wasn't postponed for too long.

no, molasses didn't work for me. but i'm glad i tried it. anything is worth a try--that's my feeling.

that's good that it's been going ok for you with the miralax regimen you're on--wonderful! and oh yes--whatever keeps you from getting impacted again--that's the way to go.

oh i love soft boiled eggs. and my cholesterol has been good so my doc told me it was ok to eat three or four eggs a week if i wanted to as long as i limit my cholesterol intake from other foods correspondingly on my "egg days". her advice is sound--i looked it up online and found that the mayo clinic and others agree with her... eggs do have a lot of good nutrients in them. we eat those eggland's best eggs. they have less cholesterol and less saturated fat than regular eggs. i've always heard fresh eggs are terrific in flavor!

yes i agree with you on the GF foods. very expensive. i tested negative for celiac. tried going GF for a bit anyway but it didn't help my constipation any.

hope your appointment next week goes well. take care.


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## Stevect06 (Jun 20, 2014)

Went to the doctor's appointment today. I'm gad I've done research online and joined this forum - that gave me a certain level of expectation. Meaning, I didn't expect the doctor to give me definite remedy or plan right then and there. He agreed when I suggested I may have motility situation, and/or slow transit. He agreed with that it could be influenced by diet, sounds like unfortunately beans and rice are a thing of the past for me. Same with bananas - although I've heard elsewhere that can depend on their ripeness whether they'll help or hinder the process. Not taking any chances though.

Overall, I really didn't gain a lot of knowledge from the appointment, except to confirm much of what I've learned by doing online research is accurate. I'm not discouraged. I realize the digestive system, when not functioning properly, can be a very difficult to treat. If the intestines aren't moving things along like they should - then what does one do? Unfortunately more extreme cases mention surgery, which many times really means removal of some or all. What was somewhat encouraging is the doctor endorses what I've been doing - Miralax 2x per day (usually) and reducing fiber. As you've said - fiber is not our friend (for those with a slow transit condition). That I learned here, thanks to you. The doctor also supports reasearch for information and forums to be used in a reasonable and sensible way.

Even though I'm in my fifties I still need to get over expecting to see a doctor older than I. This one was probably in his thirties, hadn't shaved for a few days and reminded me of Adam Lavine. Nothing wrong with that - but I think in general the profession is overwhelmed, my appointment began over an hour late. I'm glad the doctor didn't want to schedule another colonoscopy soon as I had one just over a year ago. He did say I shouldn't wait 5 years like originally recommended by the doctor last year. In a year I've been 'cleaned out' 5 times.

That's great your cholesterol level affords you several eggs a week! My ex gave me another which I'll have Saturday. I'll keep the Egglands brand in mind if buying them at the store. I've been using Eggbeaters which are ok - but nothing like the whole egg!

Interesting you've considered celiac disease to be a cause, and like me, tested negative and tried gluten free with the same results. I certainly wouldn't go gluten free unless I had to! Almost seems like a fad. A discount grocery store in this area called Aldi's had a big section in their flyer promoting their new gluten free line of foods.

I hope all is well with you and yours - thanks again for the reponse.


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## annie7 (Aug 16, 2002)

thanks for the update. sounds like you have a good doctor--he sounds well informed and, thanks to your research, so are you, which is good.. yes, i find it really helpful to be as informed and proactive as possible. a good doctor appreciates that. that's good he endorses your current treatment regimen. it's always good to know you're on the right track.

and oh yes, you are so right. our digestive systems are very difficult to treat--very tricky, very sensitive, a lot going on in there and what works for one person may not work for another. we're all so different. all this makes being a gastro doc quite challenging. they are doctors, not magicians. that's great you have such a realistic attitude about the whole thing. believe me, it helps.

oh i do know what you mean about expecting to see a doc older than we are. i haven't had a doc older than i since my early twenties..since then all my docs, specialists and surgeons have been younger--some quite a bit. makes me feel like methuselah--lol...

take care. wishing you all the best.


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