May 19, 2020
So Unfair: Serious Illness During The Pandemic
Kaye was in her mid 60’s with a long history of hypertension, a cardiac arrhythmia that had been stable for several years, and an eye condition that wasn’t well defined but seemed to be progressing. She contacted me via our website to ask if I could help with some constipation she’d been experiencing over the last month. Normally I don’t do telehealth visits for new patients (only follow-up visits for out of town patients), but nothing about the last few months had been normal and she sounded like she was struggling so I agreed to help. Her medical history was complex, and included multiple trips to the Cleveland Clinic for second opinions for her eye problems, as well as several different specialists here in Washington DC. But my part in all this seemed pretty straightforward – stool was stuck in her colon and I just needed to help her come up with a plan to get it out.
I started with the basics: “What are you eating?” Her diet was pretty good – a little too much cheese and crackers, but lots of fruit and vegetables and not too much animal protein. And she was a decent water drinker – not quite the 80 ounces I wanted her to aspire to but at least half of that most days. Next was the medicine cabinet. She wasn’t on any of the typical stuff that can block you up – no pain medications, anti-depressants, iron supplements or calcium. In terms of activity level, being housebound during a pandemic can certainly lead to more sitting around, but it wasn’t really a change from her previous baseline so that didn’t explain the recent change in her bathroom habits. She used to go at least 5 or 6 times a week but now was barely squeezing out a stingy small stool once a week. But that wasn’t the worst part; severe abdominal pressure and bloating was what prompted her to get in touch.
I recommended she double her water intake (it is plumbing, after all!), add my magic green smoothie every morning to increase her plant fiber consumption, and take a little magnesium at night to help get things going. I felt pretty confident that after a few days she’d start to see some improvement. But 4 days later and nothing was budging, and not only had her weight increased by 5 pounds, but she had gained 4 inches on her waistline. I recommended she do a “clean-out” for what I thought must be a massive accumulation of stool in her colon: 24 hours liquid diet plus a bottle of magnesium citrate – similar to what we use to prep the bowel before a colonoscopy. The next day, still nothing except more bloating and discomfort. Now I started to get worried, so I sent her to get an abdominal X-ray to make sure we weren’t dealing with a blockage. The good news: no blockage. The bad news: new onset ascites – fluid in the abdomen that can be benign but is more often associated with malignancy, infection or other bad news. An ultrasound and CAT scan confirmed the worst: widespread cancer throughout her abdomen. This was not a matter of stuck stool. This was far, far worse.
The oncology team took over at this point, arranging for a diagnostic paracentesis; a procedure where a long needle is inserted carefully into the abdomen and fluid is withdrawn and analyzed, confirming the bad news the scans had already predicted. If there is a moral to this story, it’s that our entire world has been turned upside down by this pandemic, but unfortunately, non-COVID related bad things continue to happen too, unfazed by the virus. It seems so unfair that while sheltering in place, cancer could sneak into her home and life.