Really Gross Topic - but I need your advice!
 

Well, just when you think it can't get any more humiliating.....

I am at day 4 of my 5th round of TCH, and as usual have been experiencing some constipation from the chemo and the anti-nausea drugs. I took Peri-colace for the consitipation during round 4 with good results and so have been taking it prophalactically this time as well. Today when I went to the bathroom I had some rectal bleeding - more than a little, but not a lot (make sense?). Actually thought I had come out of chemopause and started my period! I am not really constipated, so I am not straining, but I do have pre-existing hemroids (gotta love the scars of childbirth!).

So, here is my question...I really DON'T want to trot down to my local urgent care and get checked out for THIS. I think it would just send me over the edge about now. But, I don't want to be cavalier about it either. I know in non-chemo-land, this would not really be cause for alarm unless it continues, but since I am on chemo should I worry about infection? My WBC and RBC's were pretty good one day pre-chemo this time...low but just barely. What do you all think? Anyone experience anything like this?

Thanks

Hi Erin:

It sounds like you might have hemorrhoids.

Two risk factors associated with hemorrhoids are constipation (straining) and to a lessor extent doing a lot of sitting in one position without walking around. The bleeding can also be caused by irritation to the wall of the bowel (ie chemo rash occuring internally).

Bleeding probably means that you are being exposed to your own fecal bacteria. Chemo reduces the body's ability to fight bacteria - so you should probably get it checked out.

At my hospital, there are trained nurses who are assigned to the oncology dept take questions of this nature by phone and advise you as to how urgent it is. Why don't you see if there is a similar service at your hospital?

Regards,
Merridith

I too have hem. and have some bleeding. I take a pro biotic to replace the good bactaria the chemo kills in the intestinal tract. I have had a colonoscopy recently, so am not concern its anything. You should at least check with the oncology nurse to make sure there is nothing else going on here. We are all different and we are not doctors. Wishing you well, hugs, Sandy

If you don't want to go to the corner med clinic (and I don't blame you), call your cancer clinic - they will have a doc on call over the weekend. You probably have to go through the answering service and they will have whichever Onc is on call, call you back. He or she should be able to tell you over the phone if they think you can wait until Monday or whether you should go to the emergency room (which I hope not. I hate the emergency room and it seems they never do anything to help in these situations.)

Erin,

I am sorry to find you in such a predictment. The problem seems to be hemorroid but contamination by stool probably needs attention. I fully agree that emergency room is the worst part of a hospital, staffed by first year interns and overworked nurses. By all means contact your own onc any time of the day. There will be an onc on call to give you advice.

I hope you don't mind for me to address an issue that is definitely inappropriate for me to bring up. I honestly feel that your case history did not indicate your requiring chemo or radiation, which resulted in the current side-effects. Not all breast cancer patients should undergo the severest method of treatment. When a patient insisted to get the big guns to fight cancer, the oncologist has no choice but to grant the patient her wishes.

I sincerely hope you get good recovery from the discomfort.

Hello Erin,

I agree with the hemorroid issue. I, too, had some really bad constipation while on chemo and also experienced "problems." Oh, the humiliation of it all, huh?http://www.her2support.org/vbulletin...cons/icon7.gif but, hey, what are you gonna do. You are almost done YAHOO and your body will get back to normal (whatever the heck normal ishttp://www.her2support.org/vbulletin...cons/icon7.gif) is due time. Hang in there. You are doing awesome AND I think you are following a regimen that is not only SMART but is offering you the absolute greatest protection from recurrence. I don't blame you a bit for letting your onc. bring out the "big guns" - hec2neu related breast cancer NEEDS the "big guns."

Sending hugs from me to you and can't wait till we get a post from you saying "did LAST chemo today." I can almost feel your joy from where I'm sitting!

Mary Jo

Thanks, ladies for your responses. When this problem popped up this morning the first thing my DH said was "what do the women on the HER@ message board think?" - he acknowleges your collective wisdom!


I did check in with the chemo nurse, who has me watching and waiting for any untoward increase in problems/symptoms. Regarding going to the "big guns" for treatment. Actually, my onc and I were in complete agreement from the get-go regarding chemo/rads for my situation for a number of reasons. It is true we all need to make our own decisions, and they are (and should be!) based on so much more than a given set of statistics. Our personalities, our support systems, and our anxieties...all these things play a part in our health, and all need to be taken into account in our decision making.

Thank you all - AGAIN! - for being here :-)

Amen to that!http://www.her2support.org/vbulletin...cons/icon7.gifMary Jo

You may have had an anal fissure rather than hemmorroids. They are small tears in the tissue that come from constipation/hard stool trying to pass through the area. There tends to be a bit of fresh red blood in the toliet then nothing. They heal very quickly. I've had it happen to me a few times in my life (and did check with doctor) - mine was not related to the side effects of chemo... just from some straining.

Glad you checked with the nurse!

Best wishes on your upcoming final chemo.

Kathy

Erin:
I know we all make our own decisions, but I think your choice to take aggressive treatment for stage 1 disease was very, very smart. Her 2 bc is not something to fool around with, or to approach conservatively, as many women on this site can attest. With current treatments, we are now doing very well, but before herceptin, this was a very dangerous form of bc.
Sorry for your current dilemma. It sounds like a reaction to the anti constipation drugs (and yes, childbirth does stress that part of our bodies for good). You are getting to the end of the hardest part of treatment -- it really starts to get better.
Best
Linda

Erin,

If the blood is bright red you don't have to worry about it. It means that you probably have a rectal fissure or hemeroid.

Hi Erin,

I can so sympathise, having had the same thing during my chemo (which finished last November). And all the things people have written about here are what I would say, probably haemorrhoids or fissure, on chemo so don't take risk with potential infection from stools etc. My straining led to my developing two prolapses which now require surgery when I can face it....not just yet....want to enjoy a bit of non hospital life first. Ah the wonders of childbirth, which was the start of the problem 16 years ago, although on a much more minor scale.

I completely agree with everyone that of course you made an entirely sensible choice in your treatment, together with your highly qualified and experienced oncologist. We're all empowered these days to work together with our doctors, and thank goodness we now make informed decisions which give us the best possible chance. Good luck with it all, nearly there now....

I am not expert. It is not a subject I have read much on. These thoughts are based on reading and personal experience.

Breaking the Viscous Cycle Elaine Gottschall gives a short and interesting insight into the fundamental importance of the digestive process.

I saw you have started taking flax seed.

Many of the packages recommend you take with lots of water -I guess as absorbs water in the gut.

http://www.medicinenet.com/flaxseed_...al/article.htm

And as above Flax seed is reported as helping with constipation.

Dried figs will help as a gentle laxitative and fibre.

Aloe Vera may lubricate the bowel.

http://www.positivehealth.com/permit...a/aloinf20.htm

Fish oil balancing omega three and six etc will help reduce inflammation in the gut which in the longer term improves digestion promotes health etc.


Lepicol or similar provides fibre and gut flora.

http://www.lepicol.com/s/index.php

And the general healthy and difficult principles of avoiding refined foods sugar, get lots of greens etc.

The opposite extreme is not helpful either as the body is not able to digest food properly.

RB

Erin, I was so constipated during my chemo. I did TCH also. I finally started taking Senokot on a nightly basis and that did that trick. But even while doing so I had a couple times which concerned me with blood as you mentioned. I just did NOT want to go to emergency room to have tests..be looked at only to be sent home to be told to follow up with my doctor. (Story of my life.) But I did have what seemed like enough blood to worry me. But if it is from hemroids that small amount of blood from that end looks like ALOT more then it really is. (Very sensitive area as you know.) :) Add it to some "water" in the toilet and it really looks bad. I really understand your worry but under your current circumstances I am pretty sure its chemo related. Espescially if you've had hemroids. (But of course I am NOT a doctor..not even close.) lol I hope all is well with you now and your doing ok. :)

Side note on rather you should of done chemo or not. Just my opinion but IF I was you I WOULD of done chemo without a 2nd thought. When dealing with this Her2/neu bc...there is no way I would of not done everything I can and then some. At least I could live with myself knowing I did EVERYTHING and then some to increase my odds of not having it come back. I think you did the right thing. TCH for you was a GREAT choice. :)

Chelee