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
Clearing Bowel Obstruction and Decreasing Pain in 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
Decreasing pain and improving function and quality of
treatment techniques. At initial evaluation, she said she
life are important topics for patients that refuse, or are not
must reside near a hospital, due to PICC line and recurring
candidates for traditional medical interventions, and those
at end stages of disease. Patients with inoperable, metastatic
bowel carcinoma that experience pain and small bowel
She demonstrated improvement through the duration
obstruction (SBO) as a result of adhesions are a subset of
of therapy with significant pain decrease and functional
these patients. The standard treatment, adhesion and/or
increase. By discharge, her physician had removed the
resection surgery followed by post-surgical medications to
PICC lines because she had returned to eating a normal diet
prevent infection and decrease pain, may not be ideal in
(including hamburger). She was then able to travel overseas
end-stage cancer patients. We treated such a patient using a with her husband, a significant increase in her quality of life.
manual soft tissue physical therapy with goals of decreasing
her pain and alleviating symptoms of bowel obstruction
Alleviating pain and dysfunction, and returning life
secondary to adhesions successful y, using a protocol we
quality are challenging goals in patients with inoperable
developed initial y to open fallopian tubes that were blocked gastrointestinal cancer. Here we report a successful
nonsurgical treatment for abdominal adhesions, pain and
dysfunction in a terminal y ill patient. Before therapy,
The patient was a 61-year-old married woman with a
she lived with recurring SBOs, repeat surgeries, pain and
history of multiple abdominopelvic surgeries over the last
dysfunction. Her only nutrition was intravenous TPN.
12 years including hysterectomy, ileostomy and ileostomy
After undergoing this manual soft tissue physical therapy,
reversal with chemotherapy and radiation for treatment of
she was able to eat a normal diet, and participate in
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
References
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She was unable to eat or drink, so a peripheral y inserted
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that increased throughout the day with movement. The
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Nexium 40mg qd, Compazine 10mg prn, Zofran 4mg prn,
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The patient underwent 29 hours of a manual soft tissue
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Hunter Garrity awoke to the click of a gun. His grandparents kept a night-light in the utility room, but either it wasn’t working or someone had killed it—his basement bedroom was pitch-black. His breathing was a shallow whisper in the darkness. For an instant, he wondered if he’d dreamed the A voice: soft, female, vaguely mocking. “I think you dropped this.” He recognized her voice
May1, 2009 Dear Fellow Nova Scotians: I’d like to provide you with an update on the province=s efforts in dealing with HINI (human swine influenza). You are receiving this update because we have identified you, or the people and organizations you serve, as a key stakeholder who will require information and updates as we move forward. Public health professionals, in partnership with all