Clearing Bowel Obstruction and Decreasing Painin a Terminally Ill Patient via Manual Physical Therapy

Amanda D. Rice, PhD, Evette D’Avy Reed, PT, Kimberly Patterson, PTA, LMT, Belinda F. Wurn, PT, and Lawrence J. Wurn, LMT

Journal of Palliative Medicine Volume 16, Number 3, 2013

© Mary Ann Liebert, Inc. DOI: 10.1089/jpm. 2012.0458

This is a copy of an article published in the Journal of Palliative Medicine,© 2013 copyright Mary Ann Liebert, Inc.; Journal of Palliative Medicine is available online at: http://online.liebertpub.com

Decreasing pain and improving function and quality of life are important topics for patients who refuse, or are not candidates for, traditional medical interventions, and those at the end stages of disease. Patients with inoperable, metastatic bowel carcinoma who experience pain and small bowel obstruction (SBO) as a result of adhesions are a subset of these patients. The standard treatment, adhesion and/or resection surgery, followed by post-surgical medications to prevent infection and decrease pain, may not be ideal in end-stage cancer patients. We treated such a patient using manual soft tissue physical therapy with goals of decreasing her pain and alleviating symptoms of bowel obstruction secondary to adhesions successfully, using a protocol we developed initially to open fallopian tubes that were blocked by adhesions.

The patient was a 61-year-old married woman with a history of multiple abdominopelvic surgeries over the last 12 years, including hysterectomy, ileostomy, and ileostomy reversal with chemotherapy and radiation for treatment of stage IIIB ovarian/peritoneal carcinoma. She experienced SBO episodes every 2-3 months and had five adhesiolysis and/or resection surgeries to attempt to repair the bowel. Because she had undergone a recent exploratory laparoscopy that revealed metastasis to the omentum, her physicians were reluctant to perform any further surgeries, and the patient requested no more surgical interventions.

She was unable to eat or drink, so a peripherally inserted central catheter (PICC line) was placed, and she received total parenteral nutrition (TPN) daily. She experienced chronic pain associated with the SBOs at a level of 4-5/10 that increased throughout the day with movement. The patient was undergoing chemotherapy and medicated with Nexium 40mg qd, Compazine 10mg prn, Zofran 4mg prn, Ativan 1mg qd, multivitamin bid, Vitamin D 2000mg qd, Co-Enzyme Q10 qd, and Dilaudid prn for pain. Her goals were to relieve the abdominal pain, decrease SBO incidents, eat a normal diet, and travel.

The patient underwent 29 hours of manual soft tissue physical therapy, 1–6 times over six months, focused on detaching the abdominal adhesions and was instructed in self-treatment techniques. At initial evaluation, she said she must reside near a hospital, due to the PICC line and recurring SBOs.

She demonstrated improvement through the duration of therapy with significant pain decrease and functional increase. By discharge, her physician had removed the PICC lines because she had returned to eating a normal diet (including hamburger). She was then able to travel overseas with her husband, a significant increase in her quality of life.

Alleviating pain and dysfunction, and improving life quality are challenging goals in patients with inoperable gastrointestinal cancer. Here we report a successful nonsurgical treatment for abdominal adhesions, pain, and dysfunction in a terminally ill patient. Before therapy, she lived with recurring SBOs, repeated surgeries, pain, and dysfunction. Her only nutrition was intravenous TPN. After undergoing this manual soft tissue physical therapy, she was able to eat a normal diet and participate in activities she desired.

References

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“If the information in this article sounds like it may relate to what you’re experiencing, the team at Clear Passage® Physical Therapy is here to help. Many people living with this condition simply want to know if there is a natural treatment option without drugs or surgery that could work for them. The good news is you don’t have to figure it out alone. You can request more information to speak with a knowledgeable team member who will review your situation and help you understand whether this specialized therapy may be a good fit. If you’re ready to move forward, you can also apply for therapy so the clinical staff can carefully review your health history and determine the best path toward relief. Taking a few minutes to reach out could be the first step toward getting answers—and possibly getting your life back.”